pulpotomy in immature permanent teeth
In partial pulpotomy (Cvek pulpotomy), 2 mm of the pulp below the exposure are removed, leaving a wound of healthy pulp, where dressing should be … Reporting bias and other bias were not observed in the included studies. TAP is another bacterial paste that was analyzed in Eppa’s research [19]. Pediatric endodontics: endodontic treatment for theprimary and young permanent dentition. More high-quality studies in this filed are expected in the near future to address the clinical question: When undergoing pulpotomy for immature permanent teeth, which medicament should we choose? High-resolution images describe in depth each clinical step of all the procedures reviewed in the chapter. Of the five studies, four were parallel trials and the remaining study was a split-mouth trial. Pulpotomy is a conservative therapy performed to remove the inflamed coronal portion of the pulp and preserve the vitality of the remaining radicular pulp. Materials for pulpotomy in immature permanent teeth: a systematic review and meta-analysis. Preserving the dental pulp, or part of it, is important when treating a vital tooth with an exposed pulp, particularly if the tooth is immature and root formation is incomplete. Partial pulpotomy has been shown to be the treatment of choice in traumatically exposed pulps of immature permanent teeth where the pulp is recently exposed and not extensively contaminated (Figure 17.3). Thirdly, using root or tooth as a single unit for outcome assessment should be further discussed. The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Asgary S, Eghbal MJ, Parirokh M. Sealing ability of a novel endodontic cement as a root-end filling material. Keywords: CALCIUM HYDROXIDE; HEMORRHAGE CONTROL; IMMATURE … Background: J Biomed Mater Res. As more pulpotomy dressing agents are being introduced in the treatment of pulp exposure caused by caries or trauma, the different treatment outcomes of each agent should be evaluated. All the five included studies had high risk of bias. 2 However, MTA can cause tooth discoloration. In Case 1, pulpotomy was performed in a single session, while in Case 2 two sessions were required to complete the treatment. Would you like email updates of new search results? During this period, the roots are short, the root apices are wide open, the dentine is relatively thin and the dentine tubules are relatively wide, increasing the … 2014;737503. Camp JH, Fuks AB. Abscess remedy is described to be an updated radiopaque bacterial paste consists of cresol, polyoxymethylene, cinnamon oil and excipient [19]. "MTA"-an hydraulic silicate cement: review update and setting reaction. Keywords: Pulpotomy, Immature permanent teeth, Pulp exposure, Randomized controlled trials, Systematic reviews Background Immature permanent teeth, also known as young permanent teeth, are used to describe teeth with incomplete root forma-tion. Comparison of mineral trioxide aggregate and calcium hydroxide as pulpotomy agents in young permanent teeth (apexogenesis). Pulpotomy was conducted in vital immature permanent teeth with open apex (in human). All authors have read and approved the manuscript. The authors assume that the resin degrade due to the contact of saliva might lead to the marginal discoloration and a long-term follow up is needed to elucidate the outcomes. J Clin Diagn Res. Dent Mater. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Int J Paediatr Dent. Immature permanent teeth, also known as young permanent teeth, are used to describe teeth with incomplete root formation. PubMed Google Scholar. An ideal pulpotomy dressing material should be biocompatible, capable of hard tissue formation, have disinfectant properties and lack of cytotoxity. In addition to the important phase of post-eruptive enamel maturation, the roots of newly erupted permanent teeth will take up to 3 years before their growth is completed. Partial pulpotomy for immature permanent teeth, its present and future. We pooled the two studies with 55 teeth in the MTA group and 54 teeth in the CH group (Özgür 2017 reported 1 tooth dropped out at this period in the CH group). Clipboard, Search History, and several other advanced features are temporarily unavailable. Both El-Meligy 2006 and Özgür 2017 compared MTA with CH. MTA pulpotomy as an alternative to root canal treatment in children's permanent teeth in a dental public health setting. Direct pulp capping and vital pulpotomy are two accepted clinical modalities to preserve tooth vitality in cases of pulp exposure in carious young permanent teeth but the success rates are often less than 50%. Clinical success was defined as no pain, no abscess or fistulation, no excessive tooth mobility and no swelling. http://www.aapd.org/media/Policies_Guidelines/BP_PulpTherapy.pdf, https://www.aae.org/specialty/clinical-resources/guide-clinical-endodontics/, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12903-019-0917-z, Dental techniques; tools, materials and surgical research. J Dent. With proper case selection and indication, calcium hydroxide pulpotomy may be a feasible and valuable treatment modality for immature permanent teeth, even those associated with a radiographic image suggestive of periapical lesion. 2010;43:565–71. Shojaee NS, Adl A, Jafarpur D, et al. The aim of this meta-analysis and systemic review is to synthesize the available evidences to compare different pulpotomy dressing agents for pulpotomy treatment in immature … Fifty-four teeth in the MTA group were clinically and radiographically successful and 53 teeth in the CH group. Pediatr Dent. If the pulpotomy treatment is about to succeed, microbiota should be properly reduced, abscess remedy and TAP both function as antibacterial agents to improve the treatment outcome [26]. Correspondence to It is more likely to have a high success rate in baby teeth and an immature permanent tooth that is vital to an older permanent tooth. 2008;41:408–17. It allowed the tooth to maintain its vitality and continue its root development. Pulp degeneration stops root formation, leaving teeth with open apex. Coronal discoloration induced by calcium-enriched mixture, mineral trioxide aggregate and calcium hydroxide: a spectrophotometric analysis. After screening titles and abstracts, a full-text assessment of 12 articles was conducted by 2 independent investigators (inter-reviewer agreement, kappa = 0.91). Iran Endod J. Özgür 2017 reported 2 teeth in the MTA group at 18 months and 1 tooth in the CH group at 24 months with marginal discoloration of the restorations, but no significant correlation was found between marginal integrity failures and the clinical/radiographic failures (P > 0.05) [18]. Therefore, alternative choices of pulpotomy dressing agents are being provided to provide more significant induction of dentine formation, higher biocompatibility and better cost-effectiveness. 2018;9:158–63. It is mainly performed on primary teeth (on children) and is used to treat tooth decay that has extended to the pulp. The indication of this pulpotomy procedure is when pulp exposure occurs during caries removal in a primary tooth with a normal pulp or reversible pulpitis or after a traumatic pulp exposure. eCollection 2020 Dec. See this image and copyright information in PMC. [31]. Part of According to the guideline of American Association of Endodontists (AAE) and AAPD, the objective of pulpotomy is to prevent the clinical symptoms, avoid root resorption and breakdown of periodontal tissue as well as to radiographically observe continued root growth, neither of them mentioned that complete apical closure must be achieved [2, 40]. 2006;28:399–404. Albuquerque DS, Gominho LF, Santos RA. MTA is considered superior to CH in clinical and radiographic aspects in primary molar as a result of better biocompatibility of MTA [24]. Dent Mater. 10th ed. Pulpotomy is one of the most widely used methods in preserving vital pulp in teeth, which is of great significance in achieving continue root formation in immature permanent teeth suffering from dental caries or trauma. There is only weak evidence of increased success rate in using MTA and triple antibiotic paste (TAP) rather than abscess remedy. 2013;7:2644–6. sixth edition. [18] Asgary S, Eghbal MJ, Ehsani S. Periradicular regeneration after endodontic surgery with calcium-enriched mixture cement in dogs. 2016;10(3):437–42. No Article Media. C) Munksgaard, 1993. 2014;737503. Contemp Clin Dent. Mass E, Zilberman U. Microbial leakage will cause infection and hence affect the success of pulp treatment [39]. Int J Paediatr Dent 2013; 23(1): 56-63. 17-11). YC, XLC, FJZ and JXD conducted the literature search, carried out the data extraction and quality assessment, analyzed the data, and drafted and revised the manuscirpt. 2015;41:1139–45. doi: 10.1016/j.dental.2011.04.010. This clinical trial was performed in a pediatric dentistry department, and a total of 33 patients were included (16 had one affected tooth, and 17 had two affected teeth). 24 However, since an immature permanent tooth has thin root dentin walls, this treatment plan is challenging. Int J Paediatr Dent. Young permanent teeth Partial Pulpotomy for Carious Exposures Partial pulpotomy is also indicated in young permanent teeth with pulp exposure due to caries, provided that the bleeding can be controlled within several minutes. In an immature tooth an additional aim is to facilitate continued root development and apical closure. Unfortunately, there are no objective or definitive tests to determine the health of the pulpo-dentinal complex in the primary or immature permanent tooth. As a common adverse event for MTA, crown discoloration caused by the oxidation of heavy metal oxides (ie. The aim of this meta-analysis and systemic review is to synthesize the available evidences to compare different pulpotomy dressing agents for pulpotomy treatment in immature permanent teeth. Namour M, Theys S. Pulp revascularization of immature permanent teeth: a review of the literature and a proposal of a new clinical protocol. Pediatric endodontics: endodontic treatment for the primary and young permanent dentition. Results were consistent in the 6-month and 12-month follow-ups that no significant difference was observed between the use of MTA and CH. J Dent. 2014;40:599–605. Council on Clinical Affairs (2014) Pulp therapy for primary and immature permanent teeth –guideline of American Academy of pediatric dentistry . 2017;43(10):1593–601. Pediatr Dent. Only 4 out of 20 cases in the abscess remedy group failed. Also, the studies should have at least 6 months of follow-up, report clinical and radiographic success in detail and publish in English. Accessed 5 June 2019. Distribution of posterior permanent teeth, treated with partial pulp- otomy after pulp exposure due to caries, with respect to the observation period, maturity of roots and occurrence of a failure: denotes one separate case of failure. Having at least 6-month follow-up period. A comparative study of histologicresponse to different pulp capping materials Anda novel endodontic cement. In the MTA group 2 roots were not interpretable and 4 roots dropped out 6 months. Vital pulp therapies have been used in primary teeth and immature permanent teeth. 2016;44:1–7. The result of this study agrees with the aforementioned theories. Abstract — The material comprised 37 young posterior teeth with deep carious lesions and exposed pulps, treated with partial pulpotomy and dressed with calcium hydroxide. This study compared clinical, histologic, and inflammatory outcomes of Biodentine and Bioactive glass (70S30C-BAG) as pulpotomy agents in primary teeth. Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review--part III: clinical applications, drawbacks, and mechanism of action. 2019. https://www.aae.org/specialty/clinical-resources/guide-clinical-endodontics/. 9th ed. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. ansrt2@yahoo.com OBJECTIVE: To compare clinical and radiographic outcomes of pulpotomy … A meta-analysis was performed to evaluate the success rate at 6 months and 12 months. Platelet-rich fibrin is a second-generation platelet concentration with autologous nature that equips it with higher biocompatibility than synthetic materials such as MTA [27]. Int J Health Sci (Qassim). Pulpotomy Technique Preserving Vitality of Traumatized Anterior Permanent Immature Teeth The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. All of the included studies were evaluated to have a high risk of bias due to the types of interventions that do not permit the blinding of the operators. Hecova et al. Listing a study does not mean it has been evaluated by the U.S. Federal Government. When there was statistically significant heterogeneity (I2 > 50%), a random-effect model was used to analyze the data; otherwise (I2 ≤ 50%), a fixed-effect model was used instead. Int Endod J. To assess the outcome of mineral trioxide aggregate (MTA) complete pulpotomy in permanent teeth with carious exposures. Pathways of the Pulp. Physico-chemical properties of MTA and a novel experimental cement. Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized clinical trial. completed root development in immature teeth, Table 1. 2016;11:23–8. Pulp therapy for immature permanent teeth should be reevaluate radiographically 6 and 12 months after treatment and then periodically at the discretion of the clinician. Nosrat A, Seifi A, Asgary S. Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized clinical trial. Anitua E, Andia I, Ardanza B, et al. The Cvek Pulpotomy on Immature Permanent Teeth. Pulpal bleeding can … Based on the current limited evidence, MTA and CH had similar outcome of pulpotomy in immature permanent teeth, which was consistent with previous research in permanent teeth with closed apices [12] but different with the conclusion drawn by previous systematic review in primary molars [13]. It is important to develop biocompatible treatment directed at … This paper reviews the application of partial pulpotomy in immature permanent teeth and provides prognostic and technique guidance. J Biomed Mater Res A. Comparative evaluation of three different materials: mineral trioxide aggregate, triple antibiotic paste, and abscess remedy on apical development of vital young permanent teeth. Agreement between reviewers in the selection procedure was calculated by the Cohen’s kappa statistics, assuming κ = 0.6 as an eligible score. (a) (b) (c) (d) Figure 3 Radiographic … In immature permanent teeth with traumatic exposed pulps, partial and total pulpotomy are the treatment of choice [6–15]. Currently available procedures include direct pulp capping, complete pulpotomy and partial pulpotomy. These failed cases were reported at 3 months. MTA and biodentine for primary teeth pulpotomy: a systematic review and meta-analysis of clinical trials. Based on the present evidence, similar success rates with MTA were found between the dressing agents CH, CEM, RPF and TAP as pulpotomy-dressing agents in the treatment of immature permanent teeth. However, most of the outcomes were based on single studies. The teeth were divided into two groups. After 12 months, 1 root was not interpretable and 4 roots dropped out in the MTA group, while 2 roots dropped out in the CEM group. J Endodont. mentioned it in their criteria but did not reported the rate of complete root closure in their results [19]. 1993;15:257–9. http://www.aapd.org/media/Policies_Guidelines/BP_PulpTherapy.pdf. Participants were randomised to Biodentine or 70S30C-BAG groups. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Yuan Chen and Xinlei Chen contributed equally to this article and should be regarded as co-first authors. Iran Endod J. 2012;23:56–63. Mineral trioxide aggregate (MTA) is a material used worldwide in a variety of clinical applications, such as an apical barrier for teeth with immature apices, repair of root perforations, root-end lling, pulp capping, and pulpotomy We treated each tooth or root as units of analysis, and clinical and radiographic success rates were derived in this systematic review using the same criteria: deleting drop-outs and only considering patients who recalled. Stringhini JE, Dos SM, Oliveira LB, et al. Young permanent teeth are those recently erupted teeth in which normal physiological apical root closure has not occurred. It has a physical structure favorable of healing, when activated, signaling molecule were released to control the recruitment of cells, morphogenesis and process of inflammation [28, 29]. Int Endod J. El-Meligy 2006 found calcific metamorphosis in 2 teeth treated with CH and 4 teeth treated with MTA [17]. Quispe-Salcedo A, Sato T, Matsuyama J, Ida-Yonemochi H, Ohshima H. Regen Ther. The authors declared that there was no conflict of interest. Eppa HR, Puppala R, Kethineni B, et al. Pulpotomy is one of the most widely used methods in preserving vital pulp in teeth, which is of great significance in achieving continue root formation in immature permanent teeth suffering from dental caries or trauma. St. Louis: Mosby Elsevie; 2006. p. 834–59. 2). There is little difference in success rate between mineral trioxide aggregate (MTA) and calcium hydroxide (CH) at 6-month follow-up (risk ratio (RR) 1; 95% confidence interval (CI) 0.94 to 1.06) and 12-month follow-up (RR 1.04; 95% CI 0.96 to 1.13). It is a mixture of different calcium compounds including, calcium oxide, calcium phosphate, etc. Based on the limitation that mentioned above, future researches would benefit from the following strategies: Firstly, a more detailed methodology including randomization method and blinding method should be developed in future studies to enhance the quality of studies.
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