pulp treatment in primary teeth

Pulp therapy in primary teeth As pediatric dentists’ our primary goal is to perform treatment in a child efficiently and effectively, so that the child does not develop fear towards dentistry. The main aim of primary tooth pulp therapy is to maintain arch length and integrity by preserving the pulpally involved tooth as a natural space maintainer. Third, primary teeth are space maintainers for permanent successor eruption, maintain arch length and help to guide permanent dentition into place. Indirect pulp treatment in primary teeth 35 Fig. Stringhini Junior E, Vitcel ME, Oliveira LB. Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. the teeth and their supporting tissues, and the treat-ment objective is to maintain the vitality of the pulp of a tooth affected by caries, traumatic injury, or other causes (1). Cochrane Database of Systematic Reviews 2018, Issue 5. microbiological effect of calcium hydroxide protection Pediatr Dent 2000;22(4):278-86. in indirect pulp capping in primary teeth. Abstract. Materials commonly used include mineral trioxide aggregate (MTA), calcium hydroxide, formocresol or ferric sulphate. J Clin Pediatr Dent. Not logged in © 2020 Springer Nature Switzerland AG. Two review authors independently extracted data and assessed 'Risk of bias'. 2011;44(5):402–6. Pediatr Dent. Pulp therapy for baby teeth, also known as root canal, pulpotomy, pulpectomy, or nerve treatment, works to treat inflamed pulp in order to restore and save the affected tooth. The low quality is due to shortcomings in the methods used within the individual trials, the small number of children included in the trials and the short-term follow-up after treatment. In primary teeth, decay that is near the pulp (tooth nerve)is treated with either a pulpotomy or indirect pulp treatment if the tooth is not going to be extracted A pulpotomy involves removing the top 1/2 of the pulp, placing a medication/material on the pulp, covering the remaining pulp with a cement, and the restoring the tooth. When the pulp has become irreversibly infected or necrotic, a root canal treatment is indicated [2, 3]. Guideline on pulp therapy for primary and young permanent teeth. 2009;34(5):615–25. The proportion of treatment failures was low, with many of the included trials having no failures with either of the treatments being compared. The primary goal of pulp therapy is to treat, restore, and save the affected tooth. OpenGrey was searched for grey literature. Many included trials had no clinical or radiological failures in either trial arm, and the overall proportion of failures was low. For deep lesions on teeth with vital pulp, dentists should have as main objective to avoid pulpal exposure by leaving the leathery dentine on the pulp wall.1 Within this concept emerged the selective carious tissue removal (SCTR). The risk of long-term complications such as pulp necrosis, infection related resorption or ankylosis related resorption may – if left untreated – affect the formation of the permanent teeth. Pediatric pulp therapy is known by several other names, including: root canal, pulpotomy, pulpectomy, and nerve treatment. Keys to clinical success with pulp capping: a review of the literature. Pediatr Dent. Pediatric dentistry: infancy through adolescence. J Am Dent Assoc. To assess the effects of different pulp treatment techniques and associated medicaments for the treatment of extensive decay in primary teeth. Dhar V, Marghalani AA, Crystal YO, et al. Second molars and the occlusal restorations presented higher frequency of … After treatment, the cavity is filled with a medicament. Contemporary Treatment Techniques in Pediatric Dentistry, https://doi.org/10.1007/s00784-018-2472-4, https://doi.org/10.1007/s40368-015-0174-z, https://doi.org/10.1007/s00784-018-2616-6, https://doi.org/10.1002/14651858.CD003220, MCODS Mangalore, Manipal Academy of Higher Education, https://doi.org/10.1007/978-3-030-11860-0_3. Most of the diagnostic tests used in conventional endodontic therapy are of very little or no value in primary teeth and of limited value in permanent immature teeth. – Complete removal of inflamed coronal pulp tissue. . There was low-quality evidence of a difference in failure at 12 months that suggested ZOE paste may be better than Vitapex (calcium hydroxide/iodoform) paste (two trials, 161 participants). Dentists often have to perform one of three pulp treatment techniques: direct pulp capping (where a healing agent is placed directly over the exposed pulp), pulpotomy (removal of a portion of the pulp) or pulpectomy (removal of all of the pulp in the pulp chamber and root canal of a tooth). The proportion of treatment failures was low, with many of the included trials having no failures with either of the treatments being compared. It is a treatment objective to maintain the vitality of the pulp of a tooth affected by caries, traumatic injury, or other causes. The primary objective of pulp therapy is to maintain the integrity and health of the teeth and their supporting tissues. 2016;38(6):280–8. The use of cavity lining was based on the ability for reduction of the number of viable bacteria remaining, remineralization of demineralized hard tissues, induction of the reactionary dentin and protection of the integrity of the pulp. Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. One of the most common reasons for a child’s visit to dental operatory is toothache. Pinto AS, de Araújo FB, Franzon R, et al. Pediatr Dent. Compared with calcium hydroxide, MTA reduced both clinical and radiological failures, with statistically significant differences for clinical failure at 12 and 24 months. St. Louis, MO: Elsevier; 2013. p. 340–4. Yacobi R, Kenny DJ, Judd PL, Johnston DH. In case of symptoms referring to irreversible pulpitis, such as unprovoked pain, vital pulp techniques are associated with poor clinical outcomes. Treatment. Any future trials in this area would require a very large sample size and follow up of a minimum of one year. Pediatr Dent. . Pediatric dentists perform pulp therapy on both primary (baby) teeth and permanent teeth. Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. A protective liner is a thinly-applied liquid placed on the pulpal surface of a deep cavity preparation, covering exposed dentin tubules, to act as a protective barrier between the restorative material or cement and the pulp. Most of the diagnostic tests used in conventional endodontic therapy are of very little or no value in primary teeth and of limited value in permanent immature teeth. Beltrame AP, Triches TC, Sartori N, Bolan M. Electronic determination of root canal working length in primary molar teeth: an in vivo and ex vivo study. Eur Arch Paediatr Dent. Cohen’s pathways of the pulp. The risk of long-term complications such as pulp necrosis, infection related resorption or ankylosis related resorption may – if left untreated – affect the formation of the permanent teeth. American Academy of Pediatric Dentistry. Pulpotomy and pulpectomy, the two major procedures used to perform pulp therapy in primary teeth, have evolved over the years. Research could be undertaken to confirm if ZOE paste is more effective than Vitapex and to evaluate other alternatives. Pediatr Dent 2017;39(5):E146–E159. We judged the quality of the evidence suggesting the superiority of MTA over calcium hydroxide or formocresol after pulpotomy to be moderate. The trials were published between 1989 and 2017 and provided 125 comparisons of different treatment options. Communication between the oral cavity and area of furcation. Prevent the Need for Pulp Capping Pulpotomy: is MTA/Portland cement the future? If possible, your tooth may be saved through a procedure called a pulpectomy. Pediatr Dent. In children, tooth decay is among the most common diseases. 2005;18(6):347–50. The primary goal of pulp therapy is to treat, restore, and save the affected tooth. Laser light is able to vaporize the soft pulp tissue when appropriate wavelengths interact with it. They are frequently found on bitewing and periapical radiographs, but their occurrence in entire dentition is unusual. We included 87 trials that investigated the success of pulp treatment of milk teeth. According to the American Academy of Pediatric Den-tistry (AAPD) Guidelines, the primary objective of pulp therapy is to maintain the integrity and health of 4 5. Resorption of a calcium hydroxide/iodoform paste (Vitapex) in root canal therapy for primary teeth: a case report. Stringhini Junior E, dos Santos MGC, Oliveira LB, Mercadé M. MTA and biodentine for primary teeth pulpotomy: a systematic review and meta-analysis of clinical trials. This is an update of a Cochrane review first published in 2003. Indirect pulp treatment. 2018;5:CD003220. How effective are different options for treating extensive tooth decay in children's primary (milk) teeth to resolve the child's symptoms (typically pain, swelling, abnormal movement) and tooth signs (as shown on an x-ray)? Am J Dent. This is an update of a Cochrane Review published in 2014 when insufficient evidence was found to clearly identify one superior pulpotomy medicament and technique. St. Louis, MO: Elsevier; 2011. p. 808–56. 2008;30(3):230–6. The comparison between Metapex and zinc oxide and eugenol (ZOE) paste was inconclusive, with no clear evidence of a difference between the interventions for failure at 6 or 12 months (two trials, 62 participants). The evidence is current up to August 2017. 1. Pulp treatment for extensive decay in primary teeth is generally successful. Abstract. For pulpotomy, we assessed three comparisons as providing moderate-quality evidence. Coll JA. After pulpectomy, it is not clear whether any medicament is superior to another. The aim of endodontic treatment is to preserve the tooth until the time of physiological exchange, without patological changes in Similarly inconclusive, there was no clear evidence of a difference in failure between Endoflas and ZOE (outcomes measured at 6 months; two trials, 80 participants). The two major procedures used to perform pulp therapy in primary teeth, pulpotomy and pulpectomy, have evolved over the years. The pulp outcome is often unpredictable because the patient and injury which are related to variables can influence the treatment of choice and the prognosis of the case. In: Hargreaves KM, Cohen S, editors. We assessed statistical heterogeneity by using I² coefficients. Indirect pulp treatment in primary teeth 35 Fig. In many trials, there were either no clinical failures or no radiographic failures in either study arm. 1983;5(1):6–8. TREATMENT OF PRIMARY TEETH Primary teeth differ morphologically from their permanent successors both in shape and size; pulp space anatomy of primary teeth is covered in Chapter 4. .Pulpless tooth with stomas. Though primary teeth are eventually shed, they are needed for speech production, proper chewing, and to guide the proper alignment and spacing of permanent teeth. 2011;35(4):359–63. Recommendations Primary teeth. Regarding direct pulp capping, the small number of studies undertaking the same comparison limits any interpretation. Complicated crown fracture and crown-root fracture with pulp involvement expose dental pulp to the oral environment. Does Achievement of Hemostasis After Pulp Exposure Provide an Accurate Assessment of Pulp Inflammation? Diagnosis and treatment planning in primary teeth pulp therapy. The evidence suggests MTA may be the most efficacious medicament to heal the root pulp after pulpotomy of a deciduous tooth. The primary objective of pulp therapy is to maintain the integ- rity and health of the teeth and their supporting tissues. 144.76.84.133. The evaluation of MTA and Biodentine as a pulpotomy materials for carious exposures in primary teeth. 2018;28:12. Not affiliated Flaitz CM, Barr ES, Hicks MJ. In all References cases, the entire roof of the pulp chamber is removed to gain 1. .Pulpless primary molars holding orthodontic appliance . In case of symptoms referring to irreversible pulpitis, such as unprovoked pain, vital pulp techniques are associated with poor clinical outcomes. 86. 1.Test of equality of survival distributions for the different levels of group (P= 0.514). Pulpotomy for Primary Teeth with Tricalcium Silicate Material. This is a multicenter, randomized, double-blind (patient), controlled and non-inferiority clinical study on 174 primary molars and 174 primary incisors of 3-6 years-old children with carious lesions with pulp involvement. 2. Ozalp N, Saroğlu I, Sönmez H. Evaluation of various root canal filling materials in primary molar pulpectomies: an in vivo study. Pulp interventions are indicated for extensive tooth decay.Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. One of the most common reasons for a child’s visit to dental operatory is toothache. Mutluay M, Arikan V, Sari S, Kisa U. Radiographic evaluation of pulpal therapy for primary anterior teeth. Myers DR, Pashley DH, Whitford GM, McKinney RV. After a pulpotomy, one of four materials is generally used: ferric sulphate, formocresol, calcium hydroxide or mineral trioxide aggregate. Formocresol, though effective, has known concerns about toxicity. This service is more advanced with JavaScript available, Contemporary Treatment Techniques in Pediatric Dentistry Smaïl-Faugeron V, Glenny A, Courson F, Durieux P, Muller-Bolla M, Fron Chabouis H, Smaïl-Faugeron V, Glenny A, Courson F, Durieux P, Muller-Bolla M, Fron Chabouis H. Pulp treatment for extensive decay in primary teeth. The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. When pulp exposure has occurred during complete excavation in primary or young permanent teeth, (partial) pulpotomy is a treatment option for teeth diagnosed with reversible pulpitis 7, 13. Pediatric endodontics: current concepts in pulp therapy for primary and young permanent teeth. In: Casamassimo P, Fields H, Mctigue D, Nowak A, editors. Pediatr Dent. Clin Oral Investig. @article{Ranly1991ReviewingPT, title={Reviewing pulp treatment for primary teeth. As MTA is relatively expensive, future research could be undertaken to confirm if Biodentine, enamel matrix derivative, laser treatment or Ankaferd Blood Stopper are acceptable second choices, and whether, where none of these treatments can be used, application of sodium hypochlorite is the safest option. 2018; Vargas KG, Fuks AB, Peretz B. Pulpotomy techniques: cervical (traditional) and partial. After treatment, the cavity is filled with a medicament. The proportion of treatment failures was low, with many of the included trials having no failures with either of the treatments being compared. 2015;16(4):303–12. DOI: 10.1002/14651858.CD003220.pub3, Copyright © 2021 The Cochrane Collaboration. pp 75-98 | 2018;40(1):37–42. Treatment is necessary if cavity removal results in exposure of the pulp or in a primary tooth with reversible pulpitis, which means the tooth can still be saved. In recent years, … Int J Paediatr Dent. 4. traumatized primary incisors with pulp exposures or acute or chronic abscesses. After a pulpotomy, mineral trioxide aggregate (MTA) seems to be the best material (in terms of biocompatibility and efficacy) to put into contact with the remaining root dental nerve. We performed data synthesis with pair-wise meta-analyses using fixed-effect models. Abstract. Dental Pulp Treatment. 2011;35(3):255–8. The evidence showed it to be less likely to fail than either calcium hydroxide or formocresol. Pulp therapy for deciduous teeth aims to preserve the child’s health and to maintain deciduous teeth where pulp tissue is affected by caries, dental trauma, or other causes in a functional state until they are replaced by permanent teeth . Protective liner. Berlin: Quintessence; 2011. p. 173–83. Pulpless primary teeth in hemophiliacs. The 87 trials examined 125 different comparisons: 75 comparisons of different medicaments or techniques for pulpotomy; 25 comparisons of different medicaments for pulpectomy; four comparisons of pulpotomy and pulpectomy; and 21 comparisons of different medicaments for direct pulp capping. We included randomised controlled trials (RCTs) comparing interventions that combined a pulp treatment technique with a medicament or device in children with extensive decay in the dental pulp of their primary teeth. This chapter discusses contemporary pediatric endodontic concepts and definitive indications and contraindications for primary tooth pulp therapy. Introduction. Indirect pulp capping and primary teeth: is the primary tooth pulpotomy out of date? Bioactive material provides easy handling and shorter set time. Indirect pulp treatment is a procedure performed in a tooth with a deep carious lesion... ITR). Regarding direct pulp capping, the small number of studies and low quality of the evidence limited interpretation. Many materials have been used for pulp treatment in primary teeth, but not many of them are extensively supported in the dental literature. Pediatric endodontics. Int Endod J. The two major procedures used to perform pulp therapy in primary teeth, pulpotomy and pulpectomy, have evolved over the years. All were small, single-centre trials (median number of randomised teeth = 68). Clin Oral Investig. Comparison between rotary and manual techniques on duration of instrumentation and obturation times in primary teeth. The aim of this study is to evaluate the efficacy of CTZ Paste in primary teeth, compared to endodontic treatment with Guedes-Pinto Paste. Pulp treatment for extensive decay in primary teeth. Nurko C, Ranly DM, García-Godoy F, Lakshmyya KN. Background: In children, dental caries is among the most prevalent chronic diseases worldwide. Fuks AB, Kupietzki A, Guelmann M. Pulp therapy for the primary dentition. When comparing calcium hydroxide with formocresol, there was a statistically significant difference in favour of formocresol for clinical failure at six and 12 months and radiological failure at six, 12 and 24 months (six trials (one with no failures), 332 participants). Regarding pulpectomy, we found moderate-quality evidence for two comparisons. In: Splieth CH, editor. : CD003220. ASDC J Dent Child. Pulp treatment in primary teeth has been a topic of great interest in pediatric dentistry and it has gener-ated many opinions and controversial concepts. Our health evidence - how can it help you. 2000;22(6):517–20. (endodontic) treatment for exposed, infected, and/or necrotic teeth to eliminate pulpal and periradicular infection. Cite as. The main aim of primary tooth pulp therapy is to maintain arch length and integrity by preserving the pulpally involved tooth as a natural space maintainer. Many included trials had no clinical or radiological failures in either trial arm, and the overall proportion of failures was low. Pulpotomy is a dental procedure used to save decayed, infected teeth. Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health Group's Trials Register (to 10 August 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2017, Issue 7), MEDLINE Ovid (1946 to 10 August 2017), Embase Ovid (1980 to 10 August 2017) and the Web of Science (1945 to 10 August 2017). We included 40 new trials bringing the total to 87 included trials (7140 randomised teeth) for this update. The only time the AAPD recommends a direct pulp cap on a primary tooth is when the pulp is exposed due to mechanical trauma. @article{Ranly1991ReviewingPT, title={Reviewing pulp treatment for primary teeth. Accuracy of an electronic apex locator: a clinical evaluation in primary molars with and without resorption. Pulp interventions are indicated for extensive tooth decay. Formocresol may be more successful than calcium hydroxide; however, given its toxicity, any future research should focus on alternatives. In general, the enamel and dentine are thinner than in a permanent tooth. Pulpectomy (Root Canal) A pulpectomy is a root canal procedure that involves the complete removal of pulp tissue from a tooth with irreversible pulpitis or necrosis (dead tissue). There are a few reports of double teeth, but triple teeth are rare. 6 :Clinical contraidications 1. Regarding pulpectomy, there is no conclusive evidence that one medicament or technique is superior to another, and so the choice of medicament remains at the clinician's discretion. We assessed the quality of the evidence as low or very low for all comparisons. Treatment planning The first treatment decision for the young patient with one or more extensively carious primary molars is whether to retain or extract these teeth… Evolving primary pulp therapy techniques. The most common materials used for direct pulp capping are calcium hydroxide, the more recent but more expensive mineral trioxide aggregate, formocresol or an adhesive resin (placed directly over the tooth's nerve). 2018; Steffen R, Alhamoui FA, Waes HV. Outcomes of the conventional and biological treatment approaches for the management of caries in the primary dentition. When pulp exposure has occurred during complete excavation in primary or young permanent teeth, (partial) pulpotomy is a treatment option for teeth diagnosed with reversible pulpitis 7, 13. In children, dental caries (tooth decay) is among the most prevalent chronic diseases worldwide. Art. After treatment, the cavity is filled with a medicament.. Introduction. Key results Pulp treatment for extensive decay in primary teeth is generally successful. MTA also appeared to reduce radiological failure at six, 12 and 24 months (four trials, 150 participants) (low-quality evidence). PURPOSE: To evaluate clinical and radiographic outcomes of indirect pulp treatment (IPT) in primary molars after long-term function (up to 60 months). Regarding direct pulp capping, the small number of studies undertaking the same comparison limits any interpretation. Pulp interventions are indicated for extensive tooth decay. It includes a step-by-step description of both the MTA pulpotomy and a single-visit pulpectomy using rotary files in primary posterior teeth. Maintaining arch length and integrity by preserving the pulpally involved tooth, as a natural space maintainer is the main aim of primary tooth pulp therapy. World Health Organization International Clinical Trials Registry Platform, Interventions for managing immature permanent teeth with necrotic pulps, Preformed crowns for managing decayed primary molar teeth in children, Irrigating solutions for use in root canal treatment of teeth, Micro-invasive treatments for managing dental decay on adjacent tooth surfaces in children's and adults' teeth, Lasers for the removal of decay in first and permanent teeth. After treatment, the cavity is filled with a medicament.This is an update of a Cochrane review first published in 2003. One trial appeared to favour formocresol over calcium hydroxide; however, there are safety concerns about formocresol. 1989;56(3):182–5. ZOE paste may give better results than Vitapex (calcium hydroxide/iodoform) paste, but more studies are needed to confirm this and to explore other treatment options. Failures occurred after the first year of follow-up, and were detected by radiographic evaluation. In addition to these, in primary teeth it is important to preserve the tooth until its natural exfoliation time, thus preserving arch integrity(2) . This chapter discusses contemporary pediatric endodontic concepts and definitive … The main aim of primary tooth pulp therapy is to maintain arch length and integrity by preserving the pulpally involved tooth as a natural space maintainer. For other comparisons, the quality of the evidence is low or very low, which means we cannot be certain about the findings. We contacted authors of RCTs for additional information when necessary. Use of vital pulp therapies in primary teeth with deep caries lesions. Pulp stones are foci of calcification or discrete calcifications in the dental pulp. Hutcheson C, Seale NS, McWhorter A, Kerins C, Wright J. Multi-surface composite vs stainless steel crown restorations after mineral trioxide aggregate pulpotomy: a randomized controlled trial. Clinical and the treatment of deep dentinal caries in primary teeth. In: Fuks AB, Peretz B, editors. Carla Cohn, DMD. Tissue changes induced by the absorption of formocresol from pulpotomy sites in dogs. Background: In children, dental caries (tooth decay) is among the most prevalent chronic diseases worldwide. It is a treatment objective to maintain the vitality of the pulp of a tooth affected by caries, traumatic injury, or other causes. Pulp interventions are indicated for extensive tooth decay. It is a treatment objective to maintain the vitality of the pulp of a tooth affected by caries, traumatic injury, or other causes. Key results Pulp treatment for extensive decay in primary teeth is generally successful. Pulp Treatment of Triple Tooth in Primary Dentition: Two Case Reports Hankeul Jeong, Nanyoung Lee, Sangho Lee Department of Pediatric Dentistry, School of Dentistry, Chosun University Triple tooth is rare in primary dentition; it is the abnormal f usion of three teeth. This is the first part of a root canal. This is a preview of subscription content. This course discusses the direct and indirect pulp therapy in primary teeth, pulpotomy, pulpectomy and materials used for each procedure. Evidence of pulpotomy in primary teeth comparing MTA, calcium hydroxide, ferric sulphate, and electrosurgery with formocresol. This material should not prevent the resorption of the primary tooth's root, to let the permanent tooth to grow in. Pulpal treatment of primary teeth The preservation of the primary teeth whose pulp has been endangered by deep carious lesions or trauma is a major problem in primary teeth dental treatment. ment and availability of bioactive pulp medicaments additional revisions to this guideline may be indicated in future years [Goldberg, 2003]. Oper Dent. The trials were published between 1989 and 2017 and provided 125 comparisons of different treatment options. The type of pulp treatment for primary teeth should be chosen carefully based upon diagnosis … The proportion of clinical failures and radiological failures was low in all trials. It is how a dentist might describe ‘toothache.’ The pulp inside a tooth consists of vascular tissues, blood supply, nerves, and connective tissue. Review authors working with Cochrane Oral Health carried out this review of randomised controlled trials. Our site uses cookies to improve your experience. All trials were assessed at unclear or high risk of bias. Diagnosis, pulp, pulp capping, pulpotomy D iagnosis in primary and young, permanent, immature teeth varies greatly from that in fully formed permanent teeth. Pulp therapy in primary teeth As pediatric dentists’ our primary goal is to perform treatment in a child efficiently and effectively, so that the child does not develop fear towards dentistry. 1. protective base 2. indirect pulp treatment 3. coronal pulpotomy- (Direct pulp capping is a poor treatment choice for primary teeth because of higher incidence of abscess/internal resorption) 2 options for non-vital pulp therary for priamry teeth? Over 10 million scientific documents at your fingertips. Pulpotomy treatment is a very common form of vital pulp therapy. Odabaş ME, Bodur H, Tulunoğlu O, Alaçam A. Module Outline: You can succeed without pulp treatment. The trials were published between 1989 and 2017 and provided 125 comparisons of different treatment options. Background: In children, dental caries is among the most prevalent chronic diseases worldwide. The primary outcomes were clinical failure and radiological failure, as defined in trials, at six, 12 and 24 months. Oral Health Prev Dent 2003;1(3):201-7. of formocresol pulpotomy and indirect pulp therapy in 23.
pulp treatment in primary teeth 2021