The formocresol pulpotomy--the past, the present, and the future.
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Biomedical subjects
Publications and source records attributed to D M Ranly.
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An investigation was conducted on the effect of formocresol treatment of the aqueous extractability and enzymatic susceptibility of excised implant tissue. The treated tissue demonstrated a decreased solubility and a diminished digestibility by trypsin, pepsin and collagenase. However, its reactivity toward hyaluronidase showed little alteration.
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This case report presents a clinical and radiographic follow-up (38 months) of pulpectomy treatment performed on maxillary primary anterior teeth using Vitapex. Vitapex was resorbed extraradicularly and intraradicularly without apparent ill effect, and proved to be clinically and radiographically successful. The present case report illustrates that even if the paste resorbs within the canals, the clinical and radiographical outcome is excellent. A longer follow-up is recommended to evaluate if there is any effect on the permanent succedaneous tooth.
The active constituents of formocresol, formaldehyde and cresol, are known toxic agents. The authors administered increments of formaldehyde until systemic morbidity was demonstrated so that tissue damage could be equated with the number of concurrent pulpotomies required to achieve a toxic body load.
This report, the first of a two-part study, was undertaken to quantitate the systemic distribution of formaldehyde from a pulpotomy site, and to compare this level to doses that elicit overt systemic pathology. Maxillary first molars of rats were pulpotomized and treated with 14C-labeled formaldehyde, for 5 minutes. Additionally, four groups of rats were infused with 10, 20, 30, or 50 percent of the first quantity applied to the site. The data show that approximately 30 percent of the 14C-formaldehyde placed in the pulp chamber was distributed systemically; 50 percent to 59 percent was expired as CO2; and 2 percent was excreted.
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Pulpotomy therapy for the primary dentition has developed along three lines: devitalization, preservation, and regeneration. Devitalization, where the intent is to destroy vital tissue, is typified by formocresol and electrocautery. Preservation, the retention of maximum vital tissue with no induction of reparative dentin, is exemplified by glutaraldehyde and ferric sulfate treatment. Regeneration, the stimulation of a dentin bridge, has long been associated with calcium hydroxide. Of the three categories, regeneration is expected to develop the most rapidly in the coming years. Advances in the field of bone morphogenetic protein (BMP) have opened new vistas in pulp therapy. Human BMPs with dentinogenic properties are becoming available through recombinant technology. We are now entering an era of pulpotomy therapy with healing as the guiding principle.
The dynamic relation of the anteroposterior and rotational growth of the mandible to the transverse arch width and dental height changes must be understood before placing endosseous implants in actively growing patients. Research models demonstrate that osseointegrated implants lack the compensatory growth mechanism of the natural dentition. Remodeling associated with skeletal growth in the region of the implant placement site could cause the implant to either become unsupported by bone or submerged within it. Implants placed after age 15 in girls and 18 in boys have the most predictable prognosis. When placed in the growing patient, dental implants should be closely monitored and carefully restored with implant prostheses designed to accommodate growth and development.