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  • Success of Mineral Trioxide Aggregate in Pulpotomized Primary Molars

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    محمد ابوالمجد
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    This document summarizes a study comparing the success of mineral trioxide aggregate (MTA) and formocresol as pulpotomy agents in primary molars. The study found that after 24 months, all MTA-treated teeth showed clinical and radiographic success, while 5 formocresol cases showed pulp pathology and 1 reported pain. A literature review found additional studies confirming MTA has superior success rates and less toxicity compared to formocresol as a pulpotomy agent. The conclusion is that MTA can be a safe and promising alternative to formocresol for pulpotomies in primary teeth.

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    This document summarizes a study comparing the success of mineral trioxide aggregate (MTA) and formocresol as pulpotomy agents in primary molars. The study found that after 24 months, all MTA-treated teeth showed clinical and radiographic success, while 5 formocresol cases showed pulp pathology and 1 reported pain. A literature review found additional studies confirming MTA has superior success rates and less toxicity compared to formocresol as a pulpotomy agent. The conclusion is that MTA can be a safe and promising alternative to formocresol for pulpotomies in primary teeth.

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    17 views21 pages

    Success of Mineral Trioxide Aggregate in Pulpotomized Primary Molars

    Uploaded by

    محمد ابوالمجد
    This document summarizes a study comparing the success of mineral trioxide aggregate (MTA) and formocresol as pulpotomy agents in primary molars. The study found that after 24 months, all MTA-treated teeth showed clinical and radiographic success, while 5 formocresol cases showed pulp pathology and 1 reported pain. A literature review found additional studies confirming MTA has superior success rates and less toxicity compared to formocresol as a pulpotomy agent. The conclusion is that MTA can be a safe and promising alternative to formocresol for pulpotomies in primary teeth.

    Copyright:

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    of 21

    Success of Mineral Trioxide Aggregate in Pulpotomized Primary Molars

    INTRODUCTION
    Pulpotomy as defined by FINN
    Pulpotomy can be defined as the complete removal of the coronal portion of the dental pulp, followed by placement of a suitable dressing or medicament that will promote healing & preserve vitality of the tooth Classification { Ranly} Devitalization( mummification, cauterization) Preservation ( minimal devitalization , Non inductive ) Regeneration ( inductive , reparative )

    Devitalization
    Intends to destroy or mummify the vital tissue Agents used
    Formocresol Electro surgery Laser

    Preservation
    Implies maintaining the maximum vital tissue with no induction of reparative dentine (Infl. spreads progressively through the pulp & that radicular pulp has great capacity to maintain healthy function if the infected, inflamed coronal tissue is removed & an appropriate wound dressing applied) Agents used ZOE Glutaraldehyde Ferric sulphate

    Regeneration
    Formation of dentine bridge( Dental pulp has an inherent capacity to produce reparative dentine when the local env. is favorable -Yamunara et al)

    Agents used

    Calcium hydroxide Emdogain ( Enamel extra cellular matrix) Bone morphogenic protein Freeze dried bone Mineral trioxide aggregate Transforming growth factor

    Pulpotomy agents remain unsatisfactory


    Due to several biologic reasons FC most popular agent for past 60 yrs ( 1st advocated by Sweet in 1930) Concerns about safety ?

    Pulpal response with inflammation & necrosis Systemic toxicity Immunogenic response( antigenecity) Mutagenecity & carcinogenecity Permanent tooth hypoplasia

    MineralTrioxideAggregate
    Was approved for human usage by FDA in 1998 Introduced to clinical dentistry By Torabinejad & Chivian in 1999 Torabinejad ( 1995 ) proved MTA to be most effective in preventing bacterial leakage & stated that its antibacterial effect is comparable to that of Calcium hydroxide Pittford et al ( 1996 ) MTA placed on mechanically exposed pulp of monkeys stimulated pulp healing with min. inflammation & dentinal bridge formation

    Several potential clinical applications of MTA


    Apexification( root end induction with 3-5mm thickness of MTA) Obturating material for permanent teeth but apical seal of GP may be better than MTA ( Paul Vizigirda et al J Endo 2004) Seal furcation perforation Capping agent for mechanically exposed pulp Case report: MTA used to obturate primary molar where no succedaneous Pulpotomy agent for primary teeth

    Composition & Properties


    Tricalcium silicate , dicalcium silicate , Tricalcium aluminate , calcium sulfate dehydrate , bismuth oxide & tetra calcium aluminoferrite Consists of fine hydrophilic particles that set in the presence of moisture. Hydration of the powder results in a colloidal gel that solidifies to a hard structure in less than 4 min PH 12.5 CS 70 Mpa Inductive effect on cementoblasts ( root end filling) Biocompatible & Low cytotoxicity Superior sealing ability Ability to set in presence of blood Bactericidal Schmitt et al 2001 reported PRO ROOT ( TULSA DENTAL ) which can be placed in tooth with Tulsa carrier, amalgam carrier, Messing gun , or hand instrument

    MTA possess new exciting potential for pulp therapy in pediatric dentistry AIM : clinically and radiographically determine effects of MTA as pulpotomy agent & compare with Formocresol Long term evaluation

    Materials & methods


    100 children selected randomly 3 8 yrs 120 teeth ,coronal pulp amputated with conventional pulpotomy tech & divided into 2 groups ( I- MTA , II- FC ) Criteria for tooth selection:
    Exposed vital tooth without signs & symptoms of

    acute infl ( NO H/o nocturnal pain) NO C/R evidence of pulp degeneration ( Excess bleeding from RC, int. root resorption, interradicular / periapical bone destruction, swelling/ sinus tract Restorable tooth

    Technique
    L.A Rubber dam application Caries removal, coronal access to de-roof the chamber Complete removal of coronal pulp, hemostasis obtained using damp sterile cotton pellet Experimental group- pulp stump covered with MTA ( 3:1 powder/saline ratio) Control group-squeezed cotton pellet moistened with Formocresol placed for 5 min on pulp stump Then covered by ZOE paste, IRM placed prior to

    restoration with SSC

    Follow up
    Clinical & radiographic evaluation every 6 months upto period of 2 years Failure :
    Internal root resorption
    Furcation radiolucency Periapical bone destruction Pain,swelling,sinus tract

    Pulp canal obliteration not regarded as failure

    Results
    Only 74/120 teeth were assessed upto 24 months First 12 mo, no C/R pathosis recorded in either group 18 mo, 4/38 FC treated showed R pathosis no C symptoms of failure , none of MTA treated showed C/R failure ( NO statistical difference) 24 mo, 5 FC cases showed pulp pathosis, 1 reported pain ; all MTA cases showed C/R success. ( Statistically significant )

    Review of literature
    C/R studies demonstrated success rate of FC range from 70-97% ( Berger1965, Fuks & Bimstein 1981 , Morown et al 1975,rolling & Thylstrup 1975 ) Effectiveness judged by histological criteria, method can not be considered ideal coz it does not promote pulp healing ( Magnusson 1978 )

    Eidelman et al 2001 compared the effect of MTA to Fc as pulp dressing agent in 45 pulpotomized M ( C/R evaluation 6-30 Mo).MTA showed 100 % success ( No int. resorption). PCO was found in 7/41 cases not regarded as failure.concluded that MTA has promising potential to become replacement of FC in primary teeth.

    Hadeer A.Agamy et al 2004 conducted 12 Mo postoperative evaluation (C/R/H) to compare the success of gray MTA, White MTA & Fc as pulpotomy agents.C/R success were similar with both gray & white MTA which was better than FC.Histologically gray MTA was better than White and concluded that gray MTA is superior to white MTA |& Fc as pulp dressing for pulpotomized primary teeth.

    Naik .S & Hegde A.H 2005 conducted a study to evaluate the clinical efficacy of MTA as pulpotomy agent on Primary molars & found the promising 100% success rate at 6 Mo evaluation( C/R).No dentine bridge formation observed .discoloration of crown was observed with MTA which was masked by SSC.concluded MTA to be superior pulpotomy medicament over Fc.

    DISCUSSION
    Present study also showed perfect success rate with MTA throughout 24 Mo. Though Fc has been a gold standard, according to Block it should not be brought in contact with human tissue. MTA placed directly on pulp tissue reduces the risk of subsequent inflammation. ZOE can cause pulpal inflammation & subsequent int. resorption in Fc treated cases while MTA separates pulp from the irritating effects of ZOE( possible reason for lack of int. resorption) PCO/ calcific metamorphosis is the result of odontoblastic activity & suggests that tooth retains vitality hence not regarded as Failure.

    Dentine bridge formation( release of cytokines which stimulate bone cell proliferation and mature osteoblast activity).preserves odontoblastic layer and delicate fibro cellular matrix with reparative dentine formation. Less cytotoxic, non mutagenic Biocompatible material material which prevents micro leakage as well. Less time for the procedure Increased cost & less availability to be noted. Mix gets messy if excess moisture present.so all irrigation to be done before MTA placement.

    CONCLUSION
    Based on all the evidences, we conclude that MTA can be used as a safe medicament for pulptomy in cariously exposed vital primary teeth and could be a promising alternative for formocresol

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