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[A study concerning radiographic diagnosis in dental caries of primary teeth. 1. The investigation on the indications for pulpotomy with formocresol].

The prognosis in the pulpotomy procedure with Formocresol during primary teeth has an excellent clinical results. On the other hand, some reports of a poor prognosis in radiographic findings were found. To obtain valuable information about the indications for pulpotomy procedures is quite difficult in the case of children concerning. In 1972, Kurihara reported radiographic findings the indications for the pulpotomy procedure in primary molars with a stable stage having no root absorption. The authors investigated the clinical and radiographic changes 6 months after the pulpotomy procedure with Formocresol. 26 primary lower molars having four criteria obtained from 3 to 7 year old patients were treated, and 4 primary lower molars were used as controls without the criteria. We found that the dental lamina dura were an especially important finding to judge the indications for pulpotomy with Formocresol in primary molars.

Child

Distribution of 14C-formaldehyde after pulpotomy with formocresol.

Pulpotomies were performed on rhesus monkeys with use of formocresol to determine if there was uptake of 14C-formaldehyde into the systemic circulation after formocresol pulpotomies. Five-minute exposure of pulpal tissue to the 14C-formocresol resulted in the systemic absorption of approximately 1% of the dose. Two hours of exposure of pulp tissue to the 14C-formocresol did not increase the systemic absorption. Multiple sequential pulpotomies resulted in proportionately higher systemic absorption of 14C-formaldehyde. Application of 131I to pulpotomy sites indicated that formocresol compromises the microcirculation of the dental pulp. Autoradiography disclosed extensive concentrations of 14C-formaldehyde in the pulp, dentin, periodontal ligament, and bone.

Absorption

[Histopathologic study on the application of synthetic hydroxyapatite and alpha-tricalcium phosphate for vital pulpotomy].

Hydroxyapatite (HAp) and alpha-Tricalcium phosphate (alpha-TCP) are generally known as materials biocompatible to human tissue. In this study, the adaptation of HAp and alpha-TCP as a pulpotomy agent was studied histopathologically. In this study, HAp granules with a sintering temperature of 1,200 degrees C and sieved through a 37 micron sieve, and APATITE LINER TYPE I (Sankin CO.) as alpha-TCP were used. Calcium hydroxide served as a control. The physical properties of these experimental materials were evaluated and the reaction of pulp tissue to the materials was examined histolongically in dogs. alpha-TCP mixed with saline solution showed more homogeneous and higher viscosity than HAp mixed with saline solution. When alpha-TCP was applied on the site of exposure of a pulp following pulpotomy, the mechanically harmed pulp tissue was healed earlier than when HAp was applied. A hard tissue was formed earliest when calcium hydroxide was used, and then in the order of alpha-TCP and HAp. When HAp was applied, osteodentin was formed and when alpha-TCP was applied, dentin was formed on the site of exposure of a pulp following pulpotomy. When HAp or alpha-TCP was applied, the calcification in the initial stage was not observed. The calcification in initial stage was observed when calcium hydroxide was applied. These results suggest that alpha-TCP is useful as a pulpotomy agent.

Animals

Vascularization after pulpotomy.

The vascular changes of the pulpal vessels in experimentally induced pulpotomy in dog tooth were investigated using microcorrosive resin casts technique and scanning electron microscopic examination. The pulpal tissues of the permanent mandibular molars were amputated and then dressed with calcium hydrate. At one to eight weeks after pulpotomy, the experimental teeth were prepared for resin casts of pulpal vessels with hard tissues. One week after pulpotomy, a concave region, which was supposed to be due to the compression by the calcium hydrate, was found in the newly formed pulpal vascular network. Around the concave region was a flat, dense capillary network. In eight weeks, the thick dentin bridge was formed in close proximity to the amputated pulpal surface. The vascular network just beneath the dentin bridge changed into similar features in the three layers of the normal pulpal vascular architecture, which are (i) terminal capillary network (TCN), (ii) capillary network (CN), and (iii) venular network (VN) and which distributed in the superficial layer of the pulpal vessels.

Animals

Zinc oxide-eugenol pulpotomy and stainless steel crown restoration of a primary molar.

The most durable and reliable method of retaining a primary molar in the mouth after a pulpotomy procedure is complete-coverage restoration with a preformed stainless steel crown. This paper describes a method for performing pulpotomy and stainless steel crown restoration of a primary molar. Neither formocresol, glutaraldehyde, nor calcium hydroxide is used during the pulpotomy phase of the treatment.

Child

The floor of the pulp chamber following pulpotomy.

The purpose of this study was to investigate the incidence of pulpal floor damage caused by operator error in a standard pulpotomy exercise, and to determine if this damage produced significant changes in dentin morphology and thickness at the base of the pulp chamber. One hundred and fourteen primary molar teeth were utilized in this study, 61 having pulpotomies and the remainder untreated. The dentin thickness in the furcation was measured on all the teeth and the pulpal floor morphology was examined using both light and scanning electron microscopy. The difference in thickness of dentin in the furcation of pulpotomized and non-pulpotomized teeth was not statistically significant. Less than fourteen per cent of pulpotomized teeth showed damage to the pulpal floor and this damage was only minimal in all cases. This study therefore suggests that damage to the pulpal floor during preparation is unlikely to be a factor contributing to failure of pulpotomies.

Dental Pulp Cavity

Root canal treatment and pulpotomy in Kenya.

This study was carried out to evaluate the practice and depth of knowledge of root canal treatment and pulpotomy by dentists in Kenya. Questionnaires were prepared and mailed to 114 dentists whose addresses were available. Sixty seven (58.8%) dentists responded. Of these, 67.2% carried out root canal treatment (RCT) and 43.3% carried out pulpotomy. The main reasons given by most dentists in the public hospitals for not carrying out these procedures routinely were lack of facilities and materials. Furthermore, it was found that amongst those who carried out these procedures, some used outdated techniques and materials. In order to reduce the large number of teeth lost through extraction, materials and equipment should be made available to enable dentists carry out root canal treatment and pulpotomies routinely. It is also necessary to have continuing dental education amongst dentists to update their knowledge of these procedures.

Dentists

Experimental study of pulpotomy with calcium hydroxide-iodoform paste in dogs' immature permanent teeth.

To investigate the healing process and continuous root development following pulpotomy with improved calcium hydroxide-iodoform paste, the authors performed an experimental study of pulpotomy in immature permanent teeth. Thirty five incompletely formed root canals in dogs were used, and radiographical and histopathological observations were made. The results lead to the conclusion that pulpotomy with improved calcium hydroxide-iodoform paste is a very effective treatment for immature permanent teeth.

Animals

Comparison of Dycal and formocresol pulpotomies in young permanent teeth in monkeys.

This study compared Dycal and formocresol pulpotomies on young healthy permanent teeth with respect to continued dentinogenesis and root end development. Pulpotomy was performed on a total of forty permanent teeth with incompletely developed roots in three young stump-tailed monkeys (Macaca speciosa). Twenty teeth were treated with Dycal and twenty with formocresol. At the end of the experimental periods the animals were killed and the specimens were prepared and sectioned en bloc for histologic examination. The interval between treatment and death ranged between 7 and 797 days. Before each experimental procedure a Procion vital dye was administered as a marking agent for continued root development. Twelve of twenty teeth treated with Dycal and seventeen of twenty teeth treated with formocresol were judged to be successful as evidenced by continued root development, absence of periapical pathoses, and the presence of noninflamed or only mildly inflamed pulps. Brown and Brenn staining showed bacteria within the pulps of the teeth that failed. All but one of the teeth in this study showed evidence of continued root development as confirmed by Procion labeling.

Animals

The effect of pulp capping and pulpotomy on hard tissue bridges of contaminated pulps.

The pulp and dentine of permanent incisors in 13 young monkeys were exposed by grinding. The pulpal perforations were treated by partial pulpotomy with a tungsten carbide fissure bur after exposure for 4, 48, or 168 hours in nine animals, and by direct pulp capping after exposure for 4 or 48 hours in the remaining four animals. After haemostasis, the pulpal wounds were covered with calcium hydroxide (Dycal), followed by conventional amalgam (Revalloy). Initial and subsequent formation of hard tissue bridges over the wounds was studied by conventional histology after 1-6 months. Screening showed three categories of initial bridging development, differing in nature and rate of formation. A significant difference in the distribution of the two main categories was found between the two methods of treatment (P less than 0.02). A similar difference was observed when partial pulpotomy was performed after 168 hours compared with that performed after 4 hours (P = 0.055). No relationship was found between the initial bridging category and the eventual development of complete dentine bridges.

Animals

A clinical evaluation of root resorption by formocresol treatment in 120 cases of pulpotomy in permanent molars.

The effect of a formocresol pulpotomy of a 120 permanent molar showed external and internal resorption on distal root in lower molar, and palatal root in the upper molar. In this study 33.3% were male and 66.7% were female. The age distribution of patients was 16 to 20 years of age and 21 to 25 years of age. The rate of resorption for chronic pulpitis was more than acute pulpitis. The success of formocresol pulpotomy treatment at the end of the 10th year for acute pulpitis was 92.26% in contrast to 84% for chronic pulpitis.

Acute Disease

[A study on the application of Ga-As semiconductor laser to endodontics. The effects of laser irradiation on the activation of inflammatory cells and the vital pulpotomy].

The effects of laser irradiation on the activation of macrophage and fibroblast were examined by determining the rate of glucose utilization into the cell and the activity of lactate dehydrogenase (LDH) in culture supernatant. The laser irradiated macrophages that had been prepared from the peritoneal exudate cells, did not show any enhancement of activity, whereas fibroblast cell line (Gin 1 cell) were activated by laser irradiation. These findings suggest that laser irradiation was effective for the growth of fibroblast and induced suppressive effects for macrophage. In addition, effects of laser irradiation on the vital pulpotomy were investigated. It was observed that laser irradiation induced enhancement of calcification in wound surface and stimulated formation of calcified tissue. These observations indicate that laser irradiation is a useful method for the vital pulpotomy.

Calcification, Physiologic

Periodontal changes following coronal/root perforation and formocresol pulpotomy.

A clinical case report is presented which describes the sequelae of an iatrogenic lateral crown/root perforation and a formocresol pulpotomy. The post-operative course of the initial therapy included significant hard and soft tissue destruction and eventual tooth loss. The possible implication of the role of formocresol is discussed.

Adult

Pulpotomy of primary molars with coronal or total pulpitis using formocresol technique.

The aim of this study was to evaluate whether formocresol can be used successfully in teeth with carious exposure and a vital pulp with clinical symptoms of chronic pulpitis. Further, the study concerned the influence on the success rate of the vehicle for formocresol. Pulpotomies were performed on 81 primary molars. Radiographic and other clinical symptoms were used to divide the material into a coronal chronic and a total chronic pulpitis group. Chosen by lot, zinc oxide-eugenol or Pharmatec (a plaster-like non-eugenol cement) was used as the vehicle for formocresol. After an observation period of 2.5 years the success rate for the whole material was 55%. No statistically significant difference in the rate of success could be demonstrated either between the two diagnostic groups or between the two vehicle groups.

Bandages

Therapeutic pulpotomies in primary molars with the formocresol technique. A clinical and histological follow-up.

The results of therapeutic pulpotomies in primary molars with formocresol technique were studied by systematic follow-up. Of 84 primary lower molars in the clinical study, 56 became available for histological examination. The radiographic follow-up revealed periradicular osteitis in 10 per cent of the teeth treated. Internal root resorption was seen in 37 per cent of the teeth, or one-fifth of the roots treated. The histological examination revealed a very capricious diffusion of the medicament throughout the pulp tissue. Vital pulp remnants in the apical part of the treated roots showed no signs of healing. All pulps presented a varying number of inflammatory cells in the border zone adjacent to the formocresol-fixed region. In 80 per cent of the roots the histological sections revealed signs signs of internal resorption with or without incomplete repair tissue formation.

Child

Formocresol toxicity: is there a suitable alternative for pulpotomy of primary molars?

Some concern has been expressed in recent years about the use of formocresol for vital pulpotomy treatment of primary molars. This paper reviews the literature concerning the toxicity of formocresol and considers the evidence for the use of calcium hydroxide and glutaraldehyde. It is concluded that more work is required in this field before an alternative to formocresol can be recommended and that, in the meantime, a 1:5 dilution of the standard formocresol solution should be used but not included in the zinc oxide-eugenol sublining.

Animals

A clinical study of ferric sulfate as a pulpotomy agent in primary teeth.

Pulpotomies were performed on 83 primary molars in 62 patients. Ferric sulfate or formocresol was placed on the pulpal stumps, and teeth were followed for 3-, 6-, and 12-month periods. After the one-year follow-up, 28 of 29 teeth treated with ferric sulfate (FS group) were considered successful and 21 of 27 teeth treated with formocresol (FC group) were judged to be successful. The FS group demonstrated greater combined clinical and radiographic success than the FC group at the one-year recall (P < 0.05). Although the results of this study are promising, further study with longer observation periods is warranted before this technique can be recommended.

Chi-Square Distribution