Revista de Odontologia da UNESP
https://revodontolunesp.com.br/article/doi/10.1590/S1807-25772013000200011
Revista de Odontologia da UNESP
Review Article

Pulp therapy in deciduous teeth: therapeutic possibilities based on evidences

Terapia pulpar em dentes decíduos: possibilidades terapêuticas baseadas em evidências

Lourenço Neto, Natalino; Fernandes, Ana Paula; Marques, Nádia Carolina Teixeira; Moretti, Ana Beatriz da Silveira; Machado, Maria Aparecida de Andrade Moreira; Abdo, Ruy Cesar Camargo; Oliveira, Thaís Marchini

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Abstract

Pulpotomy of primary teeth has been the treatment of choice in cases of inflammation of the coronal pulp caused by caries or trauma with no involvement of the radicular pulp, thus avoiding the premature loss of the teeth. Not only is the diagnosis of the inflamed dental pulp required for this therapy to succeed, but also the selection of an effective and biocompatible medicament. However, none of the drugs available and recommended for pulpotomy therapy present all the requirements of an ideal pulp capping agent. Objective: Through a systematic literature review, between the years of 2000 and 2011, focusing in randomized clinical trials, systematic reviews and meta-analysis, aiming to analyze and discuss based on alternatives for the treatment of pulpotomy in human deciduous teeth. Conclusion: Scientific evidences showed that the medicaments and techniques influence were few. Thus, further and well-designed studies are suggested for clarification. The information generated in such experiments may contribute to a better understanding of the mechanisms of pulp therapy to new therapeutic approaches aimed at improving pulp therapy in deciduous teeth.

Keywords

Dental pulp, pulpotomy, tooth deciduous.

Resumo

A pulpotomia em dentes decíduos é uma técnica conservadora de terapia pulpar amplamente utilizada em Odontopediatria, sendo de fundamental importância para evitar a perda prematura desses dentes, quer seja por alterações provocadas pela cárie dentária ou traumatismo dentário. Apesar de ser uma técnica estudada há muitos anos, causa muitas controvérsias e discussões, principalmente em termos de biocompatibilidade dos medicamentos empregados e pelas dificuldades e falhas no diagnóstico da condição pulpar. Objetivo: Por meio de uma revisão sistemática da literatura, no período compreendido entre 2000 e 2011, e com enfoque em estudos clínicos randomizados, revisões sistemáticas e meta-análises, este trabalho teve como objetivo discutir, com base em evidências científicas, alternativas para o tratamento de pulpotomia em dentes decíduos humanos. Conclusão: As evidências científicas fidedignas com o uso de materiais capeadores pulpares e as técnicas de Eletrocirurgia e Laser de Baixa Potência foram escassas. Desta forma, sugere-se a realização de estudos complementares bem delineados estatisticamente para maiores esclarecimentos. As informações geradas em tais experimentos poderão contribuir para um melhor entendimento dos mecanismos da terapia pulpar, podendo gerar o desenvolvimento de protocolos com novas formas terapêuticas, que visam a melhorar a terapia pulpar em dentes decíduos.

Palavras-chave

Polpa dentária, pulpotomia, dente decíduo.

References

 


1. Nadin G, Goel BR, Yeung CA, Glenny AM. Pulp treatment for extensive decay in primary teeth. Cochrane Database Syst Rev. 2003;(1):CD003220. Review. PMid:12535462.

2. Holan G, Eidelman E, Fuks AB. Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol. Pediatr Dent. 2005; 27:129-136. PMid:15926290.

3. Peng L, Ye L, Guo X, Tan H, Zhou X, Wang C, Li R. Evaluation of formocresol versus ferric sulphate primary molar pulpotomy: a systematic review and meta-analysis. Int Endod J. 2007;40:751-757. PMid:17714467. http://dx.doi.org/10.1111/j.1365-2591.2007.01288.x

4. Sakai VT, Moretti AB, Oliveira TM, Fornetti AP, Santos CF, Machado MA, et al. Pulpotomy of human primary molars with MTA and Portland cement: a randomised controlled trial. Br Dent J. 2009;207(3):E5; discussion 128-9. Epub 2009 Jul 24.

5. Huth KC, Paschos E, Hajek-Al-Khatar N, Hollweck R, Crispin A, Hickel R, et al. Effectiveness of 4 pulpotomy techniques--randomized controlled trial. J Dent Res. 2005;84:1144-8. PMid:16304444. http://dx.doi.org/10.1177/154405910508401210

6. Ansari G, Ranjpour M. Mineral trioxide aggregate and formocresol pulpotomy of primary teeth: a 2-year follow-up. Int Endod J. 2010;43:413-8. PMid:20518934. http://dx.doi.org/10.1111/j.1365-2591.2010.01695.x

7. Subramaniam P, Konde S, Mathew S, Sugnani S. Mineral trioxide aggregate as pulp capping agent for primary teeth pulpotomy: 2 year follow up study. J Clin Pediatr Dent. 2009;33:311-4. PMid:19725237.

8. Russo MC, Holland R, Okamoto T, de Mello W. In vivo fixative effect of formocresol on pulpotomized decicuous teeth of dogs. Oral Surg Oral Med Oral Pathol. 1984;58(6):706-714. http://dx.doi.org/10.1016/0030-4220(84)90040-9

9. Liu JF. Effects of Nd:YAG laser pulpotomy on human primary molars. J Endod. 2006;32:404-7. PMid:16631836. http://dx.doi.org/10.1016/j.joen.2006.01.005

10. Eidelman E, Holan G, Fuks AB. Mineral trioxide aggregate vs. formocresol in pulpotomized primary molars: a preliminary report. Pediatr Dent. 2001;23:15-8. PMid:11242724.

11. Waterhouse PJ, Nunn JH, Whitworth JM, Soames JV. Primary molar pulp therapy--histological evaluation of failure. Int J Paediatr Dent. 2000;10:313-21. PMid:11310245. http://dx.doi.org/10.1046/j.1365-263x.2000.00211.x

12. Rivera N, Reyes E, Mazzaoui S, Morón A. Pulpal therapy for primary teeth: formocresol vs electrosurgery: a clinical study. J Dent Child. 2003;70:71-3.

13. Agamy HA, Bakry NS, Mounir MM, Avery DR. Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth. Pediatr Dent. 2004;26:302-9. PMid:15344622.

14. Farsi N, Alamoudi N, Balto K, Mushayt A. Success of mineral trioxide aggregate in pulpotomized primary molars. J Clin Pediatr Dent. 2005; 29: 307-11. PMid:16161395.

15. Percinoto C, de Castro AM, Pinto LM. Clinical and radiographic evaluation of pulpotomies employing calcium hydroxide and trioxide mineral aggregate. Gen Dent. 2006;54:258-61. PMid:16903198.

16. Aeinehchi M, Dadvand S, Fayazi S, Bayat-Movahed S. Randomized controlled trial of mineral trioxide aggregate and formocresol for pulpotomy in primary molar teeth. Int Endod J. 2007; 40: 261-7. PMid:17309744. http://dx.doi.org/10.1111/j.1365-2591.2007.01209.x

17. Moretti ABS, Sakai VT, Oliveira TM, Fornetti AP, Santos CF, Machado MA, et al. The effectiveness of MTA, calcium hydroxide and formocresol for pulpotomies in primary teeth. Int Endod J. 2008;41:547-55. PMid:18479381. http://dx.doi.org/10.1111/j.1365-2591.2008.01377.x

18. Noorollahian H. Comparison of mineral trioxide aggregate and formocresol as pulp medicaments for pulpotomies in primary molars. Br Dent J. 2008;204(11):E20. Epub 2008 Apr 18. PMid:18425074. http://dx.doi.org/10.1038/sj.bdj.2008.319

19. Zealand CM, Briskie DM, Botero TM, Boynton JR, Hu JC. Comparing gray mineral trioxide aggregate and diluted formocresol in pulpotomized human primary molars. Pediatr Dent. 2010; 32: 393-9. PMid:21070705.

20. Simancas-Pallares MA, Díaz-Caballero AJ, Luna-Ricardo LM. Mineral trioxide aggregate in primary teeth pulpotomy. A systematic literature review. Med Oral Patol Oral Cir Bucal. 2010;15: e942-6. PMid:20526246. http://dx.doi.org/10.4317/medoral.15.e942

21. Cardoso-Silva C, Barbería E, Maroto M, García-Godoy F. Clinical study of Mineral Trioxide Aggregate in primary molars. Comparsion between Grey and White MTA – A long term follow-up (84 months). J Dent. 2011;39(2):187-93. PMid:21144878. http://dx.doi.org/10.1016/j.jdent.2010.11.010

22. Kurji ZA, Sigal MJ, Andrews P, Titley K. A retrospective study of a modified 1-minute formocresol pulpotomy technique part 1: clinical and radiographic findings. Pediatr Dent. 2011;33(2):131-8. PMid:21703062.

23. Kurji ZA, Sigal MJ, Andrews P, Titley K. A retrospective study of a modified 1-minute formocresol pulpotomy technique part 2: effect on exfoliation times and successors. Pediatr Dent. 2011;33(2):139-43. PMid:21703063.

24. Erdem AP, Guven Y, Balli B, Ilhan B, Sepet E, Ulukapi I, Aktoren O. Success rates of mineral trioxide aggregate, ferric sulfate, and formocresol pulpotomies: a 24 month study. Pediatr Dent. 2011;33(2):165-70. PMid:21703067.

25. Liu H, Zhou Q, Qin M. Mineral trioxide aggregate versus calcium hidroxide for pulpotomy in primary molars. Chin J Dent Res. 2011;4(2):121-5.

26. Srinivasan D, Jayanthi M. Comparative evaluation of formocresol and mineral trioxide aggregate as pulpotomy agents in deciduous teeth. Indian J Dent Res. 2011;22(3):385-90. PMid:22048576. http://dx.doi.org/10.4103/0970-9290.87058

27. Godhi B, Sood PB, Sharma A. Effects of MTA and formocresol pulpotomy on primary molars. Contemp Clin Dent. 2011;4(2):296-301. PMid:22346156 PMCid:3276856. http://dx.doi.org/10.4103/0976-237X.91792

28. Fuks AB. Vital pulp therapy with new materials for primary teeth: new directions and treatment perspectives. Pediatr Dent. 2008; 30: 211-9. PMid:18615986.

29. Roberts HW, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate material use in endodontic treatment: a review of the literature. Dent Mater. 2008; 24: 149-64. PMid:17586038. http://dx.doi.org/10.1016/j.dental.2007.04.007

30. Zarzar PA, Rosenblatt A, Takahashi CS, Takeuchi PL, Costa Júnior LA. Formocresol mutagenicity following primary tooth pulp therapy: an in vivo study. J Dent. 2003;31:479-85. http://dx.doi.org/10.1016/S0300-5712(03)00087-3

31. Srinivasan V, Patchett CL, Waterhouse PJ. Is there life after Buckley's formocresol? Part I – a narrative review of alternative interventions and materials. Int J Paediatr Dent. 2006;16:117-27. PMid:16430526. http://dx.doi.org/10.1111/j.1365-263X.2006.00688.x

32. Cortés O, Fernández J, Boj JR, Canalda C. Effect of Formaldehyde on rat liver in doses used in pulpotomies. J Clin Pediatr Dent. 2007;31:181-4.

33. Milnes AR. Is formocresol obsolete? A fresh look at the evidence concerning safety issues. Pediatr Dent. 2008;30:237-46. PMid:18615990.

34. Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod. 1999;25:197-205. http://dx.doi.org/10.1016/S0099-2399(99)80142-3

35. Estrela C, Bammann LL, Estrela CR, Silva RS, Pécora JD. Antimicrobial and chemical study of MTA, Portland cement, calcium hydroxide paste, Sealapex and Dycal. Braz Dent J. 2000;11:3-9. PMid:11210272.

36. Torabinejad M, Pitt Ford TR, McKendry DJ, Abedi HR, Miller DA, Kariyawasam SP. Histologic assessment of Mineral Trioxide Aggregate as a root-end filling in monkeys. Int Endod J. 2009;42:408-11. PMid:19356176. http://dx.doi.org/10.1111/j.1365-2591.2009.01556.x

37. Eduardo FP, Bueno DF, de Freitas PM, Marques MM, Passos-Bueno MR, Eduardo CP, et al. Stem cell proliferation under low intensity laser irradiation: a preliminary study. Lasers Surg Med. 2008;40:433-8. PMid:18649378. http://dx.doi.org/10.1002/lsm.20646

38. Damante CA, De Micheli G, Miyagi SP, Feist IS, Marques MM. Effect of laser phototherapy on the release of fibroblast growth factors by human gingival fibroblasts. Lasers Med Sci. 2009;24:885-91. PMid:18600291. http://dx.doi.org/10.1007/s10103-008-0582-y
 

 

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