Search

Background: The effect of smear layer (SL) removal on primary tooth pulpectomy outcome has not been well elucidated., Aim: To determine the effect of SL removal on primary tooth pulpectomy outcome., Methods: This is a double-blind, randomized, and controlled clinical trial. Forty-eight patients were randomly divided into SL removal (G1 = 40 teeth) or smear layer nonremoval (G2 = 42 teeth) groups. Following the chemomechanical preparation with K-files and 2.5% sodium hypochlorite (NaOCl), teeth were irrigated with either 6% citric acid and 0.9% physiologic solution (G1) or only 0.9% physiologic solution (G2). Camphorated paramonochlorophenol was used as intracanal medication. At the second appointment, 1 week after, root canals were filled with zinc oxide-eugenol paste. Clinical and radiographical baseline criteria were stipulated equally for both groups., Results: The success rate (G1 = 91.2%; G2 = 70.0%) was statistically different (P = 0.04) between the groups. In G2, the outcome was affected significantly by pulpal necrosis (P = 0.02), pre-operatory symptoms (P = 0.02), and periapical/inter-radicular radiolucency (P = 0.04)., Conclusion: The pulpectomy outcome was improved by smear layer removal. The outcome for teeth with pulpal necrosis, pre-operatory symptoms, or periapical/inter-radicular radiolucency was significantly improved by removal of the smear layer., (© 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.)

Objective: The aim of this study was to evaluate the effectiveness of oxidative potential water (OPW) as an irrigating solution in reducing bacterial loading in necrotic pulpectomized primary teeth., Study Design: Forty necrotic teeth were included, 20 irrigated with OPW (experimental group) and 20 with 1% NaOCl (control group); in both groups, 2 microbiological samples from within the canals were taken with a sterile paper point, the first before irrigation (immediately before opening the crown), and the second after instrumentation and final irrigation (before filling). All samples were evaluated by McFarland's scale., Results: After the samples were analyzed before and after irrigation in the control group, there was a significant decrease in bacterial load, as in the experimental group (P < 0.0001). When both groups were compared post irrigation, no significant difference was observed (P = 0.1519)., Conclusion: The OPW was as effective as the NaOCl and is suggested as an alternative for irrigating after pulpectomy of necrotic primary teeth.

Background: Dental traumas are highly prevalent lesions in primary teeth, but crown-root fractures are seldom observed in primary molars. When trauma is sustained to the chin, the posterior primary teeth are at increased risk of trauma. The treatment of fractured teeth can be complicated, sometimes because of difficulties with the final restoration., Case Report: A 4-year-old girl was referred to a Specialty Dental clinic by a general dental practitioner with complaints of pain in her left mandibular posterior teeth region while biting. History revealed that she had fallen ten days before while playing. Chin laceration was sutured in the trauma centre, but no dental treatment was carried out. She was subsequently discharged. Later, she had pain while biting for which she was referred to the clinic by her general dental practitioner. Extra-oral examination demonstrated a healing laceration on the chin. Radiographic examination showed the presence of an unusual complicated crown-root fracture of the left mandibular first primary molar. Pulpectomy was carried out and the fracture was stabilised with glass ionomer cement and a preformed metal crown was placed., Follow-Up: Patient was reviewed after 3, 6 and 12 months both radiographically and clinically. Though radiographically it was found that the obturating material was resorbed completely at the 12 month visit, clinically the patient was asymptomatic until now (after 15 months). The patient is still under review., Conclusion: This case highlights the need for a systematic history and examination in all cases of dental trauma. It also demonstrates that conservative management is possible and not all primary teeth with crown-root fractures need to be extracted.

Introduction: There has been some surmise that immunocompromised patients may not be candidates for endodon tic therapy., Aim: To compare the clinical presentation, treatment, and treatment outcomes of HIV+ve and HIV-ve patients receiving endodontic therapy., Method: Fifty-nine HIV-ve and 46 HIV+ve patients who consented to join the study were sequentially selected from those presenting at the hospital. Clinical features were recorded for pain on palpation and percussion, thermal sensitivity, radiographic appearance, swelling, and time for treatment. Endodontic outcomes were assessed at 6, 12, 18 and 24 months., Results: There was no statistically significant difference in the presenting signs and symptoms of the two groups, although HIV+ve patients reported more severe pain. HIV+ve patients presented with mainly anterior teeth requiring therapy, but only three teeth (24%) had caries. Active caries was present in 71% (42) of the HIV-ve patients and in only 7% (three) of the HIV +ve patients. Treatment time for comparable teeth in the HIV-ve patients (52 minutes) was nearly half that of the HIV+ve (112 minutes) patients, mainly due to the latter experiencing excessive canal bleeding during treatment. There was no significant difference in the final outcome at 24 months, though resolution of signs and symptoms tended to occur earlier in the HIV-ve patients., Conclusions: Endodontic therapy is not contra-indicated HIV+ve patients, although treatment times may be longer, and time to full resolution may take longer in some of these patients. A comparison of endodontic treatment outcomes between HIV positive and HIV negative patients.

Introduction: The purpose of this study was to compare the anesthetic efficacy of 0.5% bupivacaine with 1:200,000 epinephrine with that of 2% lidocaine with 1:100,000 epinephrine during pulpectomy in patients with irreversible pulpitis in mandibular posterior teeth., Methods: Seventy volunteers, patients with irreversible pulpitis admitted to the Emergency Center of the School of Dentistry at the University of São Paulo, randomly received a conventional inferior alveolar nerve block containing 3.6 mL of either 0.5% bupivacaine with 1:200,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine. During the subsequent pulpectomy, we recorded the patients' subjective assessments of lip anesthesia, the absence/presence of pulpal anesthesia through electric pulp stimulation, and the absence/presence of pain through a verbal analog scale., Results: All patients reported lip anesthesia after the application of either inferior alveolar nerve block. By measuring pulpal anesthesia success with the pulp tester, lidocaine had a higher success rate (42.9%) than bupivacaine (20%). For patients reporting none or mild pain during pulpectomy, the success rate of bupivacaine was 80% and lidocaine was 62.9%. There were only statistically significant differences to the success of pulpal anesthesia., Conclusions: Neither of the solutions resulted in an effective pain control during irreversible pulpitis treatments of mandibular molars., (Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Endodontic treatment makes the tooth brittle due to loss of bulk of tooth structure, decrease in the moisture content of dentin and dentin elasticity. The following study was carried out to evaluate the effect of endodontic treatment on the fracture resistance of the tooth and reinforcing ability of three different core materials. The following study comprised of sample size of 30 deciduous second molars divided into control group (6) and test group (24). Access opening was done in 24 and 18th teeth with access opening were restored with three different core materials namely IRM (6), silver amalgam (6), GIC (6). All the 30 were subjected to fracture test using UTM (Universal testing machine)- Instron 95. Result showed a drastic reduction in the fracture resistance of the tooth on access opening (1/3rd) and out of the three core materials glass ionomer was shown to be the best core material giving the highest fracture registrance followed by silver amalgam and IRM.

Introduction: A number of vital pulp therapy techniques have been recommended to preserve pulp vitality in teeth with complicated crown fractures, especially in young patients. Calcium hydroxide has been the gold standard as a pulp capping material, but recently mineral trioxide aggregate (MTA) has been recommended. This case report describes the treatment of tooth discoloration caused by white MTA (WMTA) used for the management of a complicated crown fracture., Methods: A partial pulpotomy was performed with the use of WMTA after a complicated crown fracture of the upper right central incisor. Seventeen months later, the WMTA was removed because of tooth discoloration, and internal bleaching was performed., Results: Upon access, the WMTA was completely discolored. After it was removed, a significant color change was observed in the tooth crown, which was further improved with internal bleaching. The tooth remained vital, and a dentin bridge was confirmed clinically and radiographically., Conclusions: The recommendation to use WMTA for vital pulp therapy in the esthetic zone may need to be reconsidered. Should discoloration occur with the use of WMTA, the technique described may be used to improve the esthetics., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to evaluate, via clinical and radiographic assessment, pulpectomy outcomes performed on primary anterior teeth both with and without a citric acid solution to enhance smear layer removal., Methods: Patients with a matched pair of primary incisors (split-mouth design) with irreversible pulp changes were selected. A total of 36 teeth (18 children) received pulpectomies and were followed for 36 months. Pulpectomies were performed using sodium hypochlorite and saline solution as canal irrigants; during the last irrigation, the tooth was randomly selected to receive ( Group 1) or not receive (Group 2) the citric acid solution for smear layer removal. The roots were filled with ZOE paste., Results: Overall pulpectomy success was 90.6%. Cases with smear layer removal were successful 82.3% of the time; those without smear layer removal, 88.2%, and there were no statistical differences (P=1.00)., Conclusion: Pulpectomy with smear layer removal in primary incisors exhibited, after 36 months, a high success rate; however, comparable results were obtained when the smear layer was not removed.

Purpose: In 2007, the University of Iowa's advanced training program in pediatric dentistry replaced the traditional formocresol vital pulpotomy technique with a 5% sodium hypochlorite (NaOCl) technique. The purpose of this study was to evaluate the clinical/radiographic success over 21 months of 5% NaOCl as the medicament in primary molar pulpotomies compared to published data for formocresol and ferric sulfate pulpotomies., Methods: A retrospective chart audit was performed to evaluate results for all primary molar pulpotomies completed during a 12-month period using NaOCl. Dental records were reviewed for clinical and radiographic findings subsequent to pulp therapy. Clinical and radiographic criteria used to determine pulpotomy success were based on scientific literature., Results: One hundred ninety-two NaOCl primary molar pulpotomies were completed in 118 patients; 131 (68%) primary molars from 77 children were available for follow-up examination (mean time since pulpotomy=10.5 months). NaOCl pulpotomies had a 95% clinical and 82% overall radiographic success rate. External root resorption was the most common pathologic finding. Pulpotomy success diminished over time., Conclusions: Clinical and radiographic success rates in this study on NaOCl pulpotomies are comparable to formocresol and ferric sulfate pulpotomies reported in the literature. Further study with longer observation periods is warranted.

Unlabelled: Several materials have been used to fill root canals of primary teeth. Traditionally, zinc oxide eugenol was used for the purpose, until the introduction of calcium hydroxide and iodoform based materials. Another root canal filling material that contains zinc oxide eugenol, calcium hydroxide and iodoform is commercially available as Endoflas. The aim of the study was to evaluate and compare the efficacy of Endoflas, zinc oxide eugenol and Metapex as root canal filling materials., Method: A total of forty-five primary molars from children aged 5-9 years were selected for a one stage pulpectomy procedure. Teeth were randomly divided into three groups of fifteen teeth each based on the type of root canal filling material used. All the molars were evaluated clinically and radiographically at regular intervals of 3, 6, 12 and 18 months. The observations were tabulated and statistically analyzed., Results: Endoflas and zinc oxide eugenol showed 93.3% success, whereas a higher percentage of success was observed with Metapex (100%). Overfilling and voids were more commonly seen in teeth filled with Metapex., Conclusion: There was no significant difference between the three root canal filling materials.

Intrusive luxation is the most common trauma during early infancy which results in the displacement of the tooth into its alveolus. Depending on the severity of the intrusion, the American Academy of Pediatric Dentistry recommends either extraction or spontaneous re-eruption for the primary tooth. This case report provides a brief insight into surgical repositioning as an alternative treatment option for the management of intruded primary tooth in a 4-year-old girl., (© 2011 Australian Dental Association.)

Objective: The aim of this study was to evaluate the reduction in bacterial loading using 2% chlorhexidine gluconate as an irrigating solution in pulpectomized primary teeth., Study Design: A randomized, controlled clinical trial was performed that included primary teeth with pulp necrosis. Forty necrotic teeth were included, 20 irrigated with 2% chlorhexidine gluconate (experimental group) and 20 with sterile saline solution (control group); in all cases, 2 microbiological samples from within the canals were taken with sterile paper points, the first after the canal opening and before the first irrigation, and the second after instrumentation and final irrigation, before filling. All samples were evaluated by McFarlands scale., Results: The results were statistically analyzed by the Mann-Whitney U test. After analyzing samples before and after irrigation in the control group (saline), we found a significant decrease of bacterial load (P < 0.0002). The same occurred in the chlorhexidine group samples (P < 0.0001). When both groups were compared post-irrigation, a statistically significant difference was observed in favor of 2% chlorhexidine gluconate., Conclusion: Two percent chlorhexidine gluconate showed a greater reduction of intracanal bacterial loading compared with that observed with sterile saline solution. This irrigating solution is suggested as an alternative for pulpectomy of necrotic primary teeth.

Objective: To perform a systematic review in which the clinical research question for primary teeth with irreversible pulpal pathosis was "how pulpectomies with zinc oxide eugenol (ZOE) paste performed compared to other materials in their clinical and radiographic outcomes after twelve months or more follow-up period., Study Design: A literature survey of the electronic database (1950-2010) used the Medical Subject Headings and free text terms. Forty three references were retrieved and inclusion criteria were applied; 15 articles remained for full-text evaluation. From these, two were selected for data extraction regarding quality characteristics and results., Results: Selected studies showed moderate or high risk of bias. The overall success of pulpectomy was 80.0% (Calcicur), 60.0% (Sealapex) and varied from 85.0% to 100.0% (ZOE) and 89.0% to 100.0% (Vitapex). Solely Calcicur presented success rate significantly lower when compared to ZOE and Vitapex. These pastes lead to overfilled canals and particles of extruded ZOE were still evident even after the evaluation period. Resorption of Vitapex, Calcicur and Sealapex within the root canal was also reported., Conclusions: In primary teeth with irreversible pulpal changes ZOE pulpectomies yielded similar outcome than Vitapex and Sealapex, although there was no agreement with regard to filling materials' resorption.

This study investigates the profile of teaching primary tooth pulp therapy practiced by Brazilian dental schools. A multiple-choice questionnaire was sent by e-mail to 191 dental schools in Brazil, addressed to the pediatric dentistry Chairperson. The two-part survey consisting of multiple-choice questions regarding specific materials and techniques on pulp therapies, moreover, hypothetical clinical scenarios were presented so that the respondents could guide the treatment approach. The questionnaires were returned by 46.5% of the dental schools. Ninety-five percent of surveyed schools teach IPT for the treatment of deep carious lesions in dentin and indicate the calcium hydroxide as capping material (59.3%). The direct pulp capping is taught by 68.7% of schools and calcium hydroxide (97%) was the capping material most indicated. Pulpotomy is taught in 98.7% of schools and formocresol (1:5 dilution) was the medicament of choice (50%). All schools taught pulpectomy and Iodoform paste was the filling material preferred (55%). The results showed a lack of consensus in certain modalities and techniques for primary tooth pulp therapy taught by Brazilian dental schools.

Aim: To assess the treatment preferences amongst UK postgraduates (PG) in Paediatric Dentistry for a symbolic child with sample case history of differing caries severity in a primary molar tooth., Methods: All Paediatric Dentistry PG were contacted by e-mail and asked to participate in an on-line structured questionnaire. The survey described four different case scenarios of a 5-year-old child, presenting with a mesio-occlusal cavity in tooth 85 with varying symptoms and signs. Treatment options were listed and participants asked to select the single most preferred treatment for each case. The same scenarios were also presented for both non-anxious and dentally-anxious children and differences were analysed by Chi2 analysis., Results: Responses were received from 38/59 (F: 31; M: 7) PGs. The preformed metal crown (PMC) with Hall technique was selected as the option for patients with no indication of pulpal involvement by 4/38 and 20/38 for non-anxious and dentally-anxious patients respectively (Chi2=27.56, P=0.001, 1 dof). For a tooth with signs of pulpal involvement or symptoms the options selected were (non-anxious, dentally-anxious): zinc-oxide eugenol pulpecotomy and PMC 8/38, 2/38 (Chi2=9.85, P=0.002, 1 dof); local analgesia extraction 15/38, 2/38 (Chi2=27.22, P=0.001, 1 dof) and extraction under a general anaesthetic 0/38, 16/38 (Chi2=42.00, P=0.001, 1dof)., Conclusion: There was no consistency of response by PGs in Paediatric Dentistry within the UK. The Hall technique appeared to be a favoured option for treatment of an asymptomatic carious primary molar tooth in dentally-anxious child patients. Extraction was preferred for those with pulpal involvement for both non-anxious and dentally-anxious patients, although the suggested mode of extraction differed.

Extracting dental DNA for identification purposes is usually performed after crushing the tooth. The main disadvantage of this method is that the tooth is completely destroyed so further radiographic, anatomical or biochemical studies are no longer possible. We compared the quantities of DNA obtained by crushing the tooth and by removing pulp by standard endodontic access with trepanation of the occlusal surface and amplified DNA micro-satellites. In the series of crushed teeth, insufficient material for amplification was obtained in 78% of cases and a complete profile was obtained in only 9% of cases. Conversely, for the teeth prepared by trepanation, the profile was complete in 75% of cases and the DNA quantity was insufficient in only 3% of cases. Trepanation thus produced superior results in terms of quantity of DNA and the quality of the genetic profiles. Furthermore, it was a conservative procedure that allowed further analyses on the tooth., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To study the evolution of 308 necrotic primary teeth after pulpectomy technique with resorbable paste (Kri-1 + calcium hydroxide + metacresol-formaldehyde) after 30 months., Methods: 134 children between 2-9 years were included, among which they had 348 pulpectomized teeth. Out of these 348 teeth, 308 had necrotic pulp and were included in the study. The filling material consisted of a paste based on Walkhoff's master formula and consisted of the combination of Kri-1a (80.8% iodoform, 2.025% parachlorophenol, 1.215% menthol, 4.68% camphor and excipient 15 mg), pure calcium hydroxide and metacresol formaldehyde (metacresol 20 mg, formaldehyde 20 mg, eugenol 20 mg, eucalyptus 6 mg and excipient 40 mg). Root canal filling was performed in one session by one operator., Results: Pain, swelling, and fistula resolution was observed in most cases at the first recall. Progressive remission of radiolucent areas was also observed. A relationship between fistula and radiolucency in pre-treated furcation area was observed, and, in some cases, premature eruption of permanent teeth was recorded. Only two cases out of 308 treated teeth required extraction.

Aim: This was to evaluate the clinical and radiographic outcomes of an antibacterial drug (Metronidazole, Nidazol, IE Ulagay Ilac A.S) application as an intra-canal medicament combined with pulpectomy in infected primary molar teeth., Methods: The study material consisted of data collected from children treated at the Dental School Dept. of Paediatric Dentistry in Marmara University between 2000 and 2004. Clinical and radiographic data were collected over 2 years from patients who had received a topical application of metronidazole in root canal dressing before a pulpectomy was completed. Clinical success parameters were: no abscess formation, no fistula, no pain and no pathologic mobility at treated teeth with metranidazole dressing. The overall success and failure rates were analysed. Radiographic diagnosis was standardized between investigators and intra and inter-rater reliability assessed. Both investigators read and evaluated all radiographs, after a comparison of results, a consensus was agreed upon for each result., Statistics: All data were entered into an Excel format and SPSS 11.0 P < 0.05 were used for Windows and Chi-square for statistical analyses., Results: There were 64 molars assessed for clinical and radiographic success. Considering the eruption times, success rate was 75% as determined by the last follow up clinically and radiographically according to predetermined success criteria. In the 64 molars, 4 cases demonstrated loss of the alveolar bone, 3 exhibited varying degrees of root resorptions on radiographic examination and 3 showed clinical pathologic mobility. Fistulae were observed in only 1 case and early loss was detected in 5 cases., Conclusion: These results suggest that main factors responsible for failure may be associated with uncertain mixing proportions of the metronidazole paste and inadequate maxillary restorations. But some modifications in preparing the paste could increase its efficacy.

The goal of primary tooth pulp therapy is the preservation of the primary teeth until their normal time of exfoliation. Teeth with carious involvement approaching the pulp can be treated with a variety of approaches, including three pulpotomy techniques--diluted formocresol, ferric sulfate, and mineral trioxide aggregate--and an indirect pulp therapy technique. Accurate diagnosis of the vitality status of the pulp is critical to the success of each treatment and involves careful radiographic and clinical assessment of the teeth to make sure that they are either healthy or reversibly inflamed.

Various root canal filling materials are used to preserve a pulpally involved carious primary tooth. But there is no single material so far available to fulfill all the requirements of an ideal root canal filling material for a primary tooth. Hence this study was undertaken to evaluate clinically and radiographically the efficacy of three obturating materials - Calcium hydroxide with Iodoform (METAPEX), Zinc Oxide Eugenol with Iodoform (RC FILL) and Zinc Oxide Eugenol and Calcium hydroxide with Iodoform (ENDOFLAS) for a period of 9 months. Results show ENDOFLAS gave an overall success rate of 95.1%, METAPEX - 90.5% and RC FILL - 84.7%. In our study, we conclude that ENDOFLAS, a mixture of Zinc Oxide Eugenol and Calcium hydroxide with Iodoform fulfills most of the required properties of an ideal root canal filling for primary teeth.

Trauma to primary teeth can result in a wide range of disturbances to the underlying permanent teeth, such as dilaceration. Root dilacerations occur more commonly than crown dilacerations. This paper is a report of an 11-year-old girl with a missing maxillary left anterior tooth. Past history revealed premature loss of primary maxillary anterior teeth due to trauma. Radiographic examination revealed crown dilaceration of permanent maxillary left central incisor. An interdisciplinary approach in the management of this child is presented herewith.

Pulp therapy options in the primary dentition remain an area of debate and research. Current treatment options offer the ability to maintain many primary molars and prevent damage to the developing dentition. Proper diagnosis of the status of the primary pulp is essential to help the clinician chose the therapy that is most indicated for each child. It is important for clinicians to be familiar with current trends in this critical area of children's dentistry.

Antibacterial efficacy of formocresol, 2% gluteraldehyde and iodine-potassium iodide was assessed by obtaining cultures at consecutive appointments in multiple visit pulpectomies in primary molars. Formocresol and 2% gluteraldehyde were more effective as intracanal medicaments and caused significant reduction in the counts of aerobic and anaerobic microorganisms, thereby supporting the need for placing intracanal medicaments with antibacterial properties, in multiple visit pulpectomies in primary molars.

In this section, we analyze recent studies on pulpectomy procedures. These procedures represent an interesting example of dental treatment offered by general dentists, pediatric dentists, and endodontists. Accordingly, there is a need for a centralized source of analysis of these studies. It is our belief that this special issue might serve that function.

Objective: The objective of this study was to identify the probable factors associated with pulpectomy failure of primary teeth through qualitative analysis by histopathology (HIST) and scanning electron microscopy (SEM)., Study Design: A longitudinal clinical investigation of the efficacy of pulpectomy in primary teeth with irreversible pulp changes was carried out with 133 teeth (66 children) evaluated up to 48 months. The overall success was 86.1% during follow-up. Of the 18 teeth extracted as a result of treatment failure, 8 presented sufficiently undamaged roots to be randomly selected for HIST (n = 4) and SEM (n = 4) analysis., Results: Necrotic tissue and chronic inflammatory cells were observed in all specimens submitted to HIST as external radicular resorption associated with Howship's lacunae. SEM analysis showed apical and furcation areas heavily infected with microorganisms and Howship's lacunae., Conclusion: These findings suggest that the main factors responsible for pulpectomy failure were technique limitations associated with the morphological irregularities created by external/inflammatory resorption.

Aim: This was to determine which methods of primary pulp therapy are currently being taught in European dental schools starting with a preliminary study in the UK and Ireland., Methods: A questionnaire, based on that used in a USA study, was sent to paediatric dentistry staff at each of 18 dental schools in Ireland and the UK., Results: There was a response rate of 87%. All respondents taught the vital pulpotomy technique in primary molars but no uniformity was found regarding pulpectomy, indirect and direct pulp capping techniques. Most respondents, 92.9%, taught the use of ferric sulphate for vital pulpotomy. Formocresol, mineral trioxide aggregate and calcium hydroxide accounted for the remainder, with some respondents electing to teach different medicaments depending on whether the students were at undergraduate or postgraduate level., Conclusions: Formocresol is no longer the most commonly taught pulp medicament in dental schools in Ireland and the UK.

The partial pulpotomy can offer a superb outcome for the treatment of traumatic complicated crown fractures. The procedure is often used for dental trauma in children when the major aim of treatment is to preserve tooth vitality while providing a favorable environment for continued root development. The purpose of this paper was to review scientific evidence supporting partial pulpotomy and its high success rate and illustrate the clinical technique by presenting 2 challenging cases of complicated crown fractures with long-term follow-up.

Aim: To evaluate whether root resorption of primary molar teeth affects the accuracy of the Root ZX apex locator and to compare the Root ZX at different meter readings with direct canal measurement., Methodology: Sixty extracted primary molar teeth with root resorption affecting one sixth to one third of root length were used. The teeth were embedded in an alginate model. A K-type file was used in association with a Root ZX apex locator to measure canal length. Measurements were recorded using the Root ZX meter reading 'Apex' and '0.5 bar'. Actual tooth length was measured with a K-file to the major foramen. All measurements were read under a stereomicroscope at 15x magnification. The deviation of the Root ZX measurement from the actual canal length was determined., Results: Mean differences between Root ZX length meter reading 'Apex' and actual length were 0.01 +/- 0.23 mm whereas mean differences between Root ZX length meter reading '0.5 bar' and actual length were -0.33 +/- 0.30 mm. The Root ZX was 96.7% accurate to within +/- 0.5 mm of the apical foramen when compared with the actual canal length of primary molars with root resorption., Conclusions: Using a criterion of +/- 0.5 mm, the accuracy of the Root ZX was high and not affected by root resorption. When compared with direct canal measurement, the error in locating the apical foramen was smaller with measurement at meter reading 'Apex' than meter reading '0.5 bar'.

The management of 66 replanted avulsed permanent teeth in 46 patients over a 4-year period was studied. Treatment was compared with the recommendations in published guidelines for the management of avulsed permanent teeth. For total extra-alveolar times longer than 45 min, the pulps were extirpated in 96% of teeth. Extra-alveolar times longer than 45 min were associated with earlier pulp extirpation (median 16 days) compared with teeth with shorter extra-alveolar times (median 25 days). Endodontic treatment was postponed in teeth with open apices (median 27 days) compared with closed apices (median 15 days). Teeth in which pulps were removed within 10 days post-trauma had a lower prevalence of inflammatory root resorption compared with teeth in which pulps were removed later. Where inflammatory root resorption did occur, onset was significantly delayed when the pulp had been removed within the first 10 days. This study indicates that clinicians are following the guidelines in key areas of endodontic management of traumatized incisors resulting in more favourable outcomes.

Aim and Design: Sealers with prolonged antimicrobial activity are needed by the fact that microorganisms are commonly recovered from teeth with failed endodontic therapy. The aim of this study was to evaluate the duration of antimicrobial activity of ten root canal sealers (Apexit plus, Tubli Seal Xpress, Endoflas FS, Endomethasone, Endomethasone N, AH Plus, Epiphany, EndoRez, Ketac Endo, Roeko Seal) against Enterococcus faecalis and Candida albicans by the agar diffusion test. The zones of inhibition were examined immediately and after 24, 48, 72 hours, 5 and 7 days. Statistical analysis was done using Kruskal - Wallis test and Mann Whitney U test., Results and Conclusions: Against Enterococcus faecalis, Endoflas FS showed the largest inhibitory zones immediately and 24 hours after manipulation, whereas, there was no significant difference between Endoflas FS and Endomethasone after 48 hours. Against Candida albicans, Endoflas FS performed better than the other sealers. All the sealers (except AH Plus, Epiphany and Roeko Seal) demonstrated higher antimicrobial action in the first 24 hours after manipulation. The antimicrobial action of all the sealers (except AH Plus and Roeko Seal which showed no antimicrobial activity in any studied time and Epiphany which ceased to show any antimicrobial action after 24 hours) decreased significantly with time.

Objective: Compare the antimicrobial effectiveness of common antimicrobial paste immediately after pulp therapy and in different storage conditions., Study Design: Staphylococcus aureus, Staphylococcus epidermis, Streptococcus mutans, Streptococcus oralis, Enterococcus faecalis; Escherichia coli and Bacillus subtilis sample were used. The storage conditions utilized were: at room temperature--the paste was subjected to a natural aging process at room temperature for a 24-hour and 7, 14, 28, 60 and 90 day periods (GPRT). Refrigerator storage--the paste was placed to a natural aging process in a refrigerator at 4 degrees C for a 24 hour and 7.14, 28, 60 and 90 day periods (GPR). To perform the immediate effect analysis (GPi or zero time), of each mixture either at room or refrigerator temperature, the preparation procedure was similar, although GPR, iodoform, Rifocort and camphorated paramonochlorophenol were stored in the refrigerator and then taken out, dosed and manipulated, and had their immediate effect tested after a 1-week period at storage of 4 degrees C average temperature. The testing methodology was Dilution in Solid Medium-Agar. The Wilcoxon Test and Friedman variance analyses were used., Results: The GP paste showed antimicrobial activity at all experimental times., Conclusion: The pastes presented antimicrobial effectiveness at all experimental times.

Objective: To evaluate 2 techniques for the treatment of human primary molars with necrotic pulp and bifurcation bone loss by means of radiographic examination for 48 months., Method and Materials: Fifty-one mandibular primary molars were evaluated in children ranging from 4.5 to 6.5 years of age. The teeth with necrotic pulp and bifurcation bone loss were diagnosed by radiographic examination. The teeth were divided into 2 groups: group 1 (28 teeth) -- pulpotomy technique using formocresol as a temporary dressing between sessions and coronal chamber obturation with zinc oxide-eugenol cement; and group 2 (23 teeth) -- pulpectomy technique with calcium hydroxide paste as a temporary dressing between sessions and root canal obturation with a dense calcium hydroxide paste. Standardized radiographs were taken immediately after the fillings were completed and after 12, 24, 36, and 48 months. The radiographs were digitized and analyzed with software that outlined and measured the bifurcation radiolucency., Results: Bifurcation radiolucency reduced significantly or repaired completely for both treatments in the first 12 months. Minor radiographic reduction of the lesion was observed from 12 to 24 months, and no significant reduction of the remaining radiolucent area was observed from 24 to 48 months after treatment., Conclusion: The 2 endodontic techniques evaluated showed similar results. The main effect of treatment on the lesion repair was obtained in the first year after treatment.

Purpose: The purpose of this study was to compare clinical and radiographic success rates of zinc oxide-eugenol cement (ZOE) vs calcium hydroxide/iodoform paste (Vitapex) in pulpectomized primary molars at 6 and 12 months., Methods: Fifty-four mandibular primary molars from 42 children (average age 5.6 +/- 1.2 years) that met the inclusion criteria were allocated to either test material via block randomization. A 1-visit pulpectomy and stainless steel crown was performed by 1 investigator. The clinical and radiographic diagnoses were blindly assessed by another investigator with an intraexaminer reliability of 0.85 to 0.95 (kappa value)., Results: At 6 and 12 months, the ZOE success rates were 48% and 85%, respectively, and the Vitopex success rates were 78% and 89%. The difference in success rates between materials at 6 months was statistically significant, but at 12 months it was not., Conclusions: Vitapex appeared to resolve furcation pathology at a foster rate than zinc oxide-eugenol at 6 months, while at 12 months, both materials yielded similar results.

The Editorial Board of the Journal of Endodontics has developed a literature-based study guide of topical areas related to endodontics. This study guide is intended to give the reader a focused review of the essential endodontic literature and does not cite all possible articles related to each topic. Although citing all articles would be comprehensive, it would defeat the idea of a study guide. The topics presented in this section are formocresol pulpotomy, electrosurgical pulpotomy, and pulpectomy in primary teeth.

Objective: The aim of this study was to evaluate the clinical and radiographic success of Sealapex pulpectomies in primary teeth., Study Design: Root canals of 62 primary teeth were filled with Sealapex. The tooth was restored with a stainless steel crown, amalgam, compomer, or glass ionomer cement. Clinical and radiographic evaluations of pulpectomized teeth were performed for up to 36 months afterward., Results: The overall success rate was 92.3%. During the follow-up period, 4 teeth (7.7%) showing periapical lesion and pathologic resorption were extracted and rated as "failure." There were no statistically significant differences between success rate and extent of root canal filling material (P > .05). None of the fillings showed complete resorption in the canals. There were no significant differences among the restorative materials (P > .05)., Conclusion: Based on the results of this study it can be concluded that Sealapex can be used successfully in root canal treatment for primary teeth.

The aim of the present study was to provide a general scheme for pulpectomy of primary molars that may be useful for decision-making about negotiation of root canals and selection of appropriate instruments. A total of 160 vital primary molars in 85 patients (40 males, 45 females) aged 4-6 years were selected. After taking primary radiographs, local anesthesia was induced, and the teeth were isolated using a rubber dam. Canal accessibility index (CAI) and tooth accessibility index (TAI) were calculated according to initial file size. Mandibular first molars had either three canals (79.2%) or four canals (20.8%), and all second molars had four canals. Maxillary first molars had three canals and second molars had either three canals (70.9%) or four canals (29.1%). Lower accessibility of the mandibular first molar distobuccal root accounted for the lower accessibility of these teeth in comparison with mandibular second molars. While three-canal maxillary second molars were more accessible due to the lower accessibility of the distobuccal canal of the maxillary first molar, poor accessibility of the distal canal in four-canal second molars was responsible for the difficult accessibility of these teeth. In conclusion, it seems that the accessibility of a single canal in each tooth determines the difficulty of accessibility for any given tooth. Moreover, while primary second molars are more accessible than first molars, all of them are negotiable.

Purpose: The purpose of this study was to repeat a 1997 survey of current pulp therapy practice., Methods: The directors of dental school predoctoral pediatric dentistry programs (N=56) and board certified pediatric dentists (N=1200) were surveyed in 2005., Results: More dental schools (83%) taught indirect pulp therapy (IPT) compared to 1997. Significantly more used glass ionomer for IPT with most dental schools and diplomates not re-entering a tooth after IPT. Over 30% of schools and diplomates do direct pulp cops using glass ionomer. For pulpotomy, diluted formocresol usage decreased in dental schools (54%) while ferric sulfate significantly increased (24%) and full strength remained at 22%. Shorter placement of pulpotomy medication was noted and ZOE alone the preferred base. Pulpectomy was advocated by 85% of 2005 schools and diplomates with ZOE filler use decreasing while iodoform/calcium hydroxide filler use increasing., Conclusions: More pediatric dentists are using glass ionomer for IPT and direct pulp capping, and there was a trend away from the use of 1:5 diluted formocresol with more using ferric sulfate for pulpotomy. For pulpectomy, most use ZOE but iodoform pastes and calcium hydroxide have increased in usage since 1997 Disagreements continue concerning when to use certain pulp therapies and some directors and diplomates did not follow the AAPD guidelines.

The purpose of this study was to analyze the inflammatory response of dog's periapical tissues to 17% trisodium EDTA salt (pH 8.0) and 1% citric acid (pH 2.0). Saline was used as a control. Six adult dogs were used as the biological model of the study. The experimental units comprised 56 roots of mandibular molars (first and second) and premolars (first, second and third). After coronal opening, pulpectomy and root canal instrumentation were performed using the above-mentioned irrigating solutions. After 24 and 48 hours, the animals were euthanized and the teeth and their supporting tissues were removed and histologically processed. The sections were stained with hematoxylin and eosin and analyzed histopathologically with a light microscope at x100 magnification. The histological analysis focused on the occurrence of acute inflammatory response. The presence of swelling, vasodilatation and inflammatory cells were evaluated and the degree of inflammation was determined for each case. Data were analyzed by Fisher's exact test using the SPSS software with a confidence interval of 95% (p<0.05). 17% EDTA and 1% citric acid caused inflammatory responses in dog's periapical tissues with no significant differences to each other or to saline (control) at either the 24-hour (p=0.482) or 48-hour (p=0.377) periods. It may be concluded that the inflammatory response was of mild intensity for the tested substances.

Pulp therapy in the primary dentition remains a technique generating a tremendous amount of study. Formocresol has been and continues to be the most commonly used intrapulpal medicament despite its known ability to escape the microcirculation of the pulp. Ferric sulfate has gained significant favor as a result of formocresol's disadvantages, though at the cost of requiring a much more acute awareness of the potential for remaining disease and its ability to mask that process. Mineral trioxide aggregate perhaps offers the best immediate alternative to either of the above though at this time it is still cost-prohibitive in a practice that actively treats many children. And, as MTA has no fixative properties of its own, accurately analyzing the extent of the pulpal disease becomes even more critical to the overall success of the procedure. As with other techniques in dentistry, the debate is sure to continue for severl years to come.

Objective and Methods: This study was performed to clarify the usefulness of inductive heating system for the new endodontic therapy. Dextran magnetite complex (DM) suspensions were injected into the root canal of a permanent tooth, and the tooth was heated up to about 55.0 degrees C by alternating-current magnetic field., Results and Conclusion: The time until the temperature in the pulp cavity reached 55.0 degrees C was 328 +/- 26 s (mean +/- s.d., n = 8) in the 56 mg as Fe ml(-1) of DM concentration. The temperature in the pulp cavity could be maintained at 53.5-59.0 degrees C for 1200 s by changing the magnetic field intensity safely, while temperature elevations of the dental surface on the coronal and apical sides were 4.9 degrees and 3.7 degrees C, respectively. Thus, this inductive heating system, which has the possibility of selective heating, might be useful for eliminating residues of pulp as a new ablation therapy.

Most endodontists use ultrasonic instruments for retrograde root-end cavity preparations even though they have been found to produce cracks. In this laboratory study, thirty-six randomly chosen roots had root-end cavity preparations made with the Waterlase laser and only one questionable intra-canal crack was found. It was concluded that the Waterlase laser when used to make endodontic root-end cavity preparations produces either no cracks, or a very low percentage (2.8%) of cracks.

Objective: Outcome of pulpectomy in 2 treatment sessions with calcium hydroxide as an intracanal dressing was compared to a procedure comprising instrumentation and root-filling in 1 session., Study Design: Subjects with a vital pulp condition (N = 256) were recruited to a randomized clinical trial. Outcome parameters included radiographic signs of apical periodontitis and painful symptoms at clinical follow-ups 1 week and 1-3 years after treatment., Results: Of 244 subjects available for final recall, 17 presented with periapical radiolucency. Lesions were evenly distributed among the 2 treatment groups. Postoperative pain recorded 1 week after permanent filling was significantly associated with overfilling (P = .001), with no difference between treatment groups. There was no association with presence of overfilling and radiographic lesion at end point of recall., Conclusions: Study confirms that pulpectomy may be carried out at a high rate of success if due attention is given to aseptic operating procedures, proper instrumentation and filling. Under these conditions an interappointment dressing with calcium hydroxide does not seem to influence outcome.

Objectives: (1) To present a narrative review of the currently available alternative interventions and materials to formocresol pulpotomy for the management of extensive caries in the primary molar, and (2) to produce a clinical protocol for pulp therapy techniques in the extensively carious primary molar., Introduction: The International Agency for Research on Cancer has recently classified formaldehyde as carcinogenic to human beings. Since Buckley's Formocresol contains 19% formaldehyde in its full strength and, therefore, 1% in a 20% dilution, a safer alternative should be identified., Methods: A narrative review of the published literature for primary molar pulp therapy techniques was undertaken following an extensive and appropriate literature search. A specialist group of paediatric dentists was formed to arrive at a consensus and establish an evidence-based protocol for the management of extensively carious primary molar teeth. Part I of this paper explores the currently available alternative interventions and materials to formocresol in the form of a narrative review. The second part of the paper will present the formation of a specialist group to arrive at a consensus and establish an evidence-based protocol for the management of the extensively carious primary molar., Conclusions: After consideration of a review of extensively searched literature, a protocol and key points document have been developed to assist clinicians in their treatment planning. Further long-term studies with the highest level of evidence (i.e. randomized controlled trials) are required to enable us to identify acceptable alternatives which can replace formocresol.

Purpose: To evaluate the clinical and radiographic success of zinc oxide-eugenol (ZOE), Calcicur, Sealapex and Vitapex in primary molar pulpectomies., Methods: 80 primary molars, showing signs of pulpal and/or periapical involvement, with no abnormal mobility, were selected from 76 children aged between 4-9 years-old, free from systemic disease. Radiographic evaluation was done to exclude teeth showing internal or pathological external root resorption and/or inadequate bone support. The selected teeth (20 in each group) were randomly treated with ZOE, Sealapex, Calcicur and Vitapex. The procedure involved primarily a one-visit pulpectomy. The teeth were evaluated clinically and radiographically every 2 months for a period of 18 months., Results: In the ZOE group, all pulpectomies were successful. In the Sealapex group, two pulpectomies and in the Calcicur group, four pulpectomies showed complete resorption of the material in the root canal. Although re-treatment was performed, those teeth had to be removed due to pathological root resorption. In the Vitapex group, although six pulpectomies showed resorption of the filling material within the canals, this had no effect on the clinical and radiographical success of the treatment.

Aim: To examine whether an intra-oral injection of a nonsteroidal anti-inflammatory drug (ketorolac), in association with conventional local anaesthetic techniques, would improve the pulp extirpation rate in teeth with irreversible pulpitis., Methodology: A two group double-blind clinical trial was undertaken in the Dental Casualty Department of the University of Manchester School of Dentistry. Patients were randomly allocated to either the test or control group. The test group received an intra-oral injection of ketorolac (30 mg in 1 mL) in the buccal sulcus adjacent to the tooth being treated. After an interval of 15 min, they then received 2.2 mL of 2% lidocaine with 1 : 80 000 epinephrine by buccal infiltration in the maxilla or by inferior dental block in the mandible. The control group received an intra-oral injection of normal saline (1 mL) in the buccal sulcus adjacent to the tooth being treated, followed by the same local anaesthetic regime as the test group after the 15 min interval. Fifteen minutes after the local anaesthetic injections, pulp extirpation was attempted. All patients completed the short-form McGill pain questionnaire prior to treatment and completed identical questionnaires at 6 and 24 h after treatment., Results: The study protocol set the number of patients to be treated at twenty. However, as the study progressed it became apparent that the intra-oral injection of ketorolac caused significant pain to four of the five patients who received it; therefore the study was terminated after ten patients had been treated. The results from the patients treated showed no significant difference in the pulp extirpation rate between the test and control groups. However, patients with higher pain scores at baseline were less likely to have the pulp completely extirpated, irrespective of whether they were in the test or control group. Pain scores for all patients decreased significantly from baseline to 24 h., Conclusion: An intra-oral injection of ketorolac did not improve the pulp extirpation rate in a small group of patients with irreversible pulpitis compared with a placebo. In addition, it was associated with such significant pain on injection that it cannot be recommended as a treatment in this situation.

Purpose: The purpose of this retrospective study was to evaluate, via clinical and radiographic assessments, the treatment outcome of zinc oxide-eugenol (ZOE) pulpectomies performed in vital maxillary primary incisors successfully restored with composite resin crowns., Methods: Pulpectomized vital primary incisors were treated by a uniformed technique, filled with ZOE paste, and successfully restored with composite resin crowns. Those that remained intact and noncarious for the assessment interval were evaluated for the outcome (success or failure) based on clinical and radiographic findings and compared to: (1) the reason for treatment; (2) the canal filling extent; (3) the type of composite resin crown restoration performed; and (4) the eruption status of its succedaneous tooth., Results: For 104 maxillary primary incisors meeting the inclusion criteria, failure, as judged by presence of pathologic root resorption and/or apical lucency, was determined to be 24% (25/104), for a mean duration of 18 months observation. Failures were statistically associated with the reason for treatment (higher for trauma), the extent of ZOE paste filler in the pulp canal (higher for gross overfill), and the eruption status of the associated succedaneous permanent incisor (higher for delayed eruption)., Conclusions: This study determined a failure rate (24%) for pulpectomies-using ZOE paste and performed on vital primary incisors-comparable to that reported for nonvital pulpectomies. A statistically significant increase in failure rates was found for: (1) incisors treated for trauma (42%) vs those treated for dental caries (19%); and (2) grossly overfilled canals (80%) vs canals filled to the apex (0%).