Better outcomes in pulpotomies on primary molars with MTA:is mineral trioxide aggregate more effective than formocresol for primary molar pulpotomy?

Data sources Medline, Cochrane Library, Embase, Science Citation Index and the China National Knowledge Infrastructure were used to source articles. In addition, identified papers' reference lists and their authors' other published literature were also scanned. Study selection Studies of interest were randomised controlled trials of primary molar teeth where there was exposure of vital pulp caused by caries or trauma, with at least 6 months follow-up. It was required that selected teeth had no internal root resorption, inter-radicular and periapical bone destruction, no periodontal involvement, swelling, or sinus tract; they should be restorable with stainless steel crowns; and that outcomes were evaluated by clinical symptoms and radiographic evidence where the comparison followed a standard definition of success or failure, as shown by the number of teeth. Data extraction and synthesis Data were extracted from each study independently and entered into a database. Differences were resolved by discussion. Studies were scored for validity criteria according to the Jadad scale. Meta-analysis was performed using the software RevMan (version 4.2.8; Copenhagen; The Nordic Cochrane Centre, The Cochrane Collaboration, 2003). Heterogeneity between studies was assessed using a standard chi-square test. If there was homogeneity among the studies, the fixed-effect model (Peto method) was applied to aggregate the data. If homogeneity was rejected then sensitivity analyses were performed using a random-effects model. Results Six studies met the inclusion criteria (giving a total of 381 teeth). There was a significant difference between the success rates of formocresol (FC)- and mineral trioxide aggregate (MTA)-treated pulpotomised primary molars (P<0.05) Clinical assessments and radiographic findings of the MTA versus FC pulpotomy suggested that MTA was superior to FC in pulpotomy, resulting in a lower failure rate [relative risk, 0.32 (95% confidence interval, 0.11–0.90) and 0.31 (95% confidence interval, 0.13–0.74) respectively]. Conclusions The results demonstrate that in primary molar teeth with vital pulp exposure caused by caries or trauma, a pulpotomy performed with MTA results in better clinically and radiographically observed outcomes. Fewer undesirable responses were recorded for MTA than when FC was used. Therefore, the study supports the use of MTA instead of FC as wound dressing when performing pulpotomies on primary molars

Behandelmogelijkheden bij het oplossen van diepe carieuze laesies bij kinderen.

De behandeling van carieuze laesies is een veeleisend probleem. In de literatuur zijn preventieve en meer of minder invasieve behandelmethoden voor de behandeling te vinden. Deze serie beschrijft stapsgewijs de behandelmogelijkheden van de carieuze laesie. In Mondhygiënisten Vademecum nr. 4 stond het eerste deel met een inleiding over het cariësproces en deel twee stond in nr. 5 en ging over de preventieve behandeling. In deze artikelen wordt diepe cariës omschreven als een carieuze laesie waarvan op grond van klinische en radiologische observatie verwacht wordt dat bij het verwijderen van het geïnfecteerde dentineweefsel de pulpa wordt geëxponeerd. In deel 3 zal de indirecte pulpa overkapping, stepwise excavation en directe pulpa overkapping worden besproken

Indirect pulp treatment in a permanent molar: case reort of 4-year follow-up

This case report describes the Indirect Pulp Treatment (IPT) of deep caries lesion in a permanent molar. A 16-year-old male patient reported discomfort associated with thermal stimulation on the permanent mandibular left first molar. The radiographs revealed a deep distal caries lesion, very close to the pulp, absence of radiolucencies in the periapical region, and absence of periodontal space thickening. Pulp sensitivity was confirmed by thermal pulp vitality tests. Based on the main complaint and the clinical and radiographic examinations, the treatment plan was established to preserve pulp vitality. Clinical procedures consisted of removing the infected dentin and lining the caries-affected dentin with calcium hydroxide paste. The tooth was provisionally sealed for approximately 60 days. After this period, tooth vitality was confirmed, the remaining carious dentin was removed, and the tooth was restored. At 4-year follow-up, no clinical or radiographic pathological findings were found