Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions. Reparative hard tissue formation following calcium hydroxide application after partial pulpotomy in cariously exposed pulps of permanent teeth. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Effect of mineral trioxide aggregate and formocresol pulpotomy on vital primary teeth: a clinical and radiographic study. Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized clinical trial. Comparison of mineral trioxide aggregate and formocresol as pulp medicaments for pulpotomies in primary molars Postoperative Pain following Pulpotomy of Primary Molars with Two Biomaterials: A Randomized Split Mouth Clinical Trial Clinical assessment of mineral trioxide aggregate (MTA) as direct pulp capping in young permanent teeth. Calcium Hydroxide vs. Mineral Trioxide Aggregates for Partial Pulpotomy of Permanent Molars with Deep Caries Treatment outcomes of pulpotomy in primary molars using two endodontic biomaterials. A 2-year randomised clinical trial.
PURPOSE This manuscript presents evidence -based guidance on the use of vital pulp therapies for treatment of deep caries lesions in children . A guideline panel convened by the American Academy of Pediatric Dentistry formulated evidence -based recommendations on three vital pulp therapies : indirect pulp treatment ( IPT ; also known as indirect pulp cap ) , direct pulp cap ( DPC ) , and pulpotomy . METHODS The basis of the guideline 's recommendations was evidence from " Primary Tooth Vital Pulp Therapy : A Systematic Review and Meta- Analysis . " ( Pediatr Dent 2017;15;39[1]:16 - 23 . ) A systematic search was conducted in PubMed ® / MEDLINE , Embase ® , Cochrane Central Register of Controlled Trials , and trial data bases to identify r and omized controlled trials and systematic review s addressing peripheral issues of vital pulp therapies such as patient preferences of treatment and impact of cost . Quality of the evidence was assessed through the Grading of Recommendations Assessment , Development , and Evaluation approach ; the evidence -to-decision framework was used to formulate a recommendation . RESULTS The panel was unable to make a recommendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions . The panel recommends use of  mineral trioxide aggregate ( MTA ) and formocresol in pulpotomy treatments ; these are recommendations based on moderate- quality evidence at 24 months . The panel made weak recommendations regarding choice of medicament in both IPT ( moderate- quality evidence [ 24 months ] , low quality evidence [ 48 months ] ) and DPC ( very-low quality evidence [ 24 months ] ) . Success of both treatments was independent of type of medicament used . The panel also recommends use of ferric sulfate  ( low- quality evidence ) , lasers ( low- quality evidence ) ,  sodium hypochlorite  ( very low- quality evidence ) , and  tricalcium silicate  ( very low- quality evidence ) in pulpotomies ; these are weak recommendations based on low- quality evidence . The panel recommended against the use of calcium hydroxide as pulpotomy medicament in primary teeth with deep caries lesions . Conclusions and practical implication s : The guideline intends to inform the clinical practice s with evidence -based recommendations on vital pulp therapies in primary teeth with deep caries lesions . These recommendations are based upon the best available evidence to- date In a prospect i ve study , partial pulpotomy was performed on six permanent molars with deep carious lesions and pulpal involvement . The bleeding pulp was irrigated with normal tap water until bleeding had stopped and the exposed pulp was covered with calcium hydroxide followed by zinc oxide eugenol , and finally covered with a semipermanent restoration . All teeth showed hard tissue barrier formation , both clinical ly and radiographically , within three months and were free from subjective and objective symptoms through the observation period ( average observation period was 26 months ) . The patients also experienced the therapy positively . These findings and those of others have helped gain more recognition for partial pulpotomy as a strong possible alternative therapy when pulps are exposed by deep carious lesions and a bleeding pulp is exposed during the excavation process . The rationale for this therapy is to remove the infected and /or inflamed pulpal areas beneath the carious lesion and disintegrated tissue . A rapid and simplified procedure would allow the general practitioner to perform this procedure when necessary at dental clinics , without specialist facilities under conditions that avoid unnecessary contamination of the pulp Less invasive excavation methods have been suggested for deep caries lesions . We tested the effects of stepwise vs. direct complete excavation , 1 yr after the procedure had been carried out , in 314 adults ( from six centres ) who had received treatment of a tooth with deep caries . The teeth had caries lesions involving 75 % or more of the dentin and were central ly r and omized to stepwise or direct complete excavation . Stepwise excavation result ed in fewer pulp exposures compared with direct complete excavation [ difference : 11.4 % , 95 % confidence interval ( CI ) ( 1.2 ; 21.3 ) ] . At 1 yr of follow-up , there was a statistically significantly higher success rate with stepwise excavation , with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [ difference : 11.7 % , 95 % CI ( 0.5 ; 22.5 ) ] . In a subsequent nested trial , 58 patients with exposed pulps were r and omized to direct capping or partial pulpotomy . We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [ 31.8 % and 34.5 % ; difference : 2.7 % , 95 % CI ( -22.7 ; 26.6 ) ] . In conclusion , stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation . In view of the poor prognosis of vital pulp treatment , a stepwise excavation approach for managing deep caries lesions is recommended BACKGROUND Pulpotomy is the common therapy for cariously exposed pulps in symptom-free primary molar teeth .  Formocresol ( FC ) is considered the gold st and ard dressing agent for pulpotomy , but concerns have been raised over the years about its safety . Other alternative pulpotomy agents have been investigated and suggested . OBJECTIVE The objective was to evaluate and compare the clinical and radiographic response of FC and white mineral trioxide aggregate ( MTA ) as pulpotomy material s on primary molars . MATERIAL S AND METHODS Fifty primary molars , with deep carious lesion that exposed a vital but asymptomatic pulp , in 37 children aged 4 - 7 years were treated with conventional pulpotomy procedure .  The teeth were divided r and omly into two groups . Group I ( FC ) and group II ( MTA ) . The treated teeth were evaluated clinical ly and radiographically and were followed-up for 12 months . RESULTS At the end of the 12 months follow-up , the clinical success rates for FC and MTA were 81 % and 100 % , respectively . There was a statistically significant difference ( P = 0.04 ) between the clinical success rates of FC and MTA . While the radiographic success rates for FC and MTA were 81 % and 96 % , respectively , there was no statistically significant difference between the radiographic success of MTA and FC . CONCLUSION White MTA showed a higher clinical and radiographic success rate when compared to FC as a pulpotomy agent in vital primary molars , and it has a potential to become a replacement for FC in primary molars OBJECTIVE To compare clinical and radiographic outcomes of pulpotomy treatment using calcium-enriched mixture ( CEM ) cement and mineral trioxide aggregate ( MTA ) in carious-exposed vital immature permanent first molars . DESIGN Fifty-one immature molars with clinical carious exposure with symptomatic/asymptomatic pulpitis met the inclusion criteria and r and omly assigned to one of the treatment groups ( CEM [ 26 teeth ; 59 roots ] , MTA [ 25 teeth ; 59 roots ] ) . After performing pulpotomy and covering the radicular pulps with the bio material s , all teeth were permanently restored . Blinded clinical and radiographic evaluations were performed at 6 and 12 months after operation for signs of success or failure . Radiographs were evaluated for complete/partial apical closure . The data were analysed using chi-square test and generalized estimating equation ( GEE ) model . RESULTS There was no significant difference at the baseline between the two experimental groups . All available cases ( 49 teeth ) showed pulp survival and signs of continuous root development after 12 months . Overall , complete apical closure ( apexogenesis ) occurred in 76.8 % and 73.8 % of radiographically interpreted roots in CEM cement and MTA groups , respectively . There was no statistical difference in terms of radiographic outcomes between two groups . CONCLUSIONS Calcium-enriched mixture cement and MTA showed similar performance in pulpotomy of immature caries-exposed permanent molars Purpose The aim of this study was to compare the effect of white mineral trioxide aggregate ( MTA ) to that of formocresol ( FC ) as pulp dressing agents in pulpotomised primary molars . Methods In this clinical trial study , 60 lower second primary molars of 46 children were treated by a conventional pulpotomy technique . The teeth were r and omly assigned to the MTA ( experimental ) and FC ( control ) groups by r and om numbered table . Following removal of the coronal pulp and haemostasis , the pulp stumps were covered with an MTA paste in the experimental group . In the control group , FC was placed with a cotton pellet over the pulp stumps . The teeth of both groups were restored with stainless steel crowns . Children arrived for clinical and radiographic follow-up evaluation after 6 , 12 and 24 months . Results The treated teeth in FC group ( n = 18 ) were clinical ly and radiographically successful after 24 months . The radiographic follow-up evaluation revealed one failure ( furcation involvement ) in 18 molars treated with MTA after 24 months . The treated teeth in MTA group were clinical ly successful 24 months postoperatively . Pulp canal obliteration was observed in one of the teeth treated with MTA and four of the teeth treated with FC . Conclusion MTA could be used as a safe medicament for pulpotomy in cariously exposed primary molars and could be a substitute for FC Introduction : The aim of this r and omized clinical trial split-mouth study was to compare the postoperative pain following use of mineral trioxide aggregate ( MTA ) and calcium-enriched mixture ( CEM ) cement as pulpotomy agents in carious primary molars . Methods and Material s : Forty-seven children aged between 6 - 10 years old were enrolled in this study . Each child had two cariously involved primary molar in need of pulpotomy . After caries removal and preparing access cavity in one of the carious teeth , either MTA or CEM cement was r and omly used as the pulpotomy agent , while the other cariously involved primary molar tooth was capped with the other material in a separate visit . After covering the radicular pulp with one of the capping material s the teeth were permanently restored with stainless steel crown ( SSC ) .  Postoperative pain was recorded by using Wong-Baker faces pain rating scale ( Wong-Baker FPRS ) up to seven days following the treatment . Data was analyzed using the Wilcoxon , McNemar , and chi square tests . Results : Forty-five patients fulfilled the treatment procedure and returned the Wong-Baker FPRS forms . Overall 65.6 % of the patients reported pain irrespective of the pulpotomy agents used . There was no significant difference in postoperative pain between the teeth that received either MTA or CEM cement as pulpotomy agents in the first , second and the third day ( P=0.805 , P=0.942 , P=0.705 , respectively ) following the procedure . The trend of the pain scores showed decreasing manner during the study period for the teeth in either groups of MTA or CEM cement . There was no significant difference between the two groups in the number of analgesics used following the treatment ( P>0.05 ) . Conclusion : The findings of the present study showed that a majority of the children felt pain following pulpotomy and SSC placement ; however , there was no significant difference in pain reported when either MTA or CEM cement was used as pulpotomy agents UNLABELLED Carious pulp exposure in permanent molars of children is a common incident . Mineral trioxide aggregate is a new material that possesses numerous exciting possibilities for pulp therapy . AIM The purpose of this study was to evaluate the efficiency of MTA as a direct pulp capping agent in young permanent teeth . METHODS Thirty asymptomatic permanent molars with pulp exposures were treated by pulp capping using MTA . At each recall ( 6 12 , 18 and 24 months ) , the teeth were assessed clinical ly , through pulpal sensitivity tests , as well as radiographically to evaluate periapical healing . RESULTS None of the cases reported spontaneous pain at the six months follow up and the pulp showed signs of vitality and absence of periapical radiolucency . At 24 months , the clinical and radiographic success rate was 93 % with evidence of continued root growth . CONCLUSION Pulp capping with MTA is recommended for teeth with carious pulp exposures specially immature teeth with high potential for healing Aim : To prospect ively compare the clinical success rate of partial pulpotomy treatment in permanent molars using calcium hydroxide ( CH ) and mineral trioxide aggregates ( MTA ) as pulp dressing agents . Methods : Restorable permanent first molars ( 64 ) with carious pulp exposures were r and omly assigned to two groups ; CH and MTA . A st and ardized operative procedure was followed in both groups . Following isolation and caries removal , the exposed superficial pulp tissue layers were removed with a sterile flame shape diamond bur to a depth of 2–4 mm . Bleeding was controlled and pulp dressed with either a paste of non- setting Ca(OH)2 followed by a setting layer of Ca(OH)2 , or with grey MTA . The dressing material s in both groups were then covered with a layer of light cured glass ionomer cement . The teeth were either restored using amalgam , or where grossly carious with preformed metal crowns . Patients were scheduled for follow-up at 3 , 6 , 12 months and annually thereafter . Results : There were 34 patients ( 17 males and 17 females ) with 51 teeth available for evaluation . The age of patients at the time of restoration ranged between 6.8 to 13.3 years ( mean of 10.3 ±1.8 years ) . The follow-up period ranged from 25.4 to 45.6 months with an average of 34.8 ± 4.4 months . There was no statistically significant difference in the success rate of teeth treated with CH ( 91 % ) in comparison to teeth treated with MTA ( 93 % ) . Radiographically , a hard tissue barrier under CH was noticed in 12 ( 55 % ) teeth compared with 18 ( 64 % ) teeth under MTA ( p=0.4 ) . Conclusions : MTA has clinical success rate comparable to CH as a pulp dressing material for partial pulpotomy in permanent molars with carious AIM To compare the treatment outcomes of calcium-enriched mixture ( CEM ) cement and mineral trioxide aggregate ( MTA ) as pulp dressing bio material s in vital pulpotomy of carious primary molars . STUDY DESIGN split-mouth r and omised clinical trial . MATERIAL S AND METHODS Forty children aged 4 - 8 years with 2 carious teeth requiring pulpotomy were selected and r and omly assigned to MTA ( n = 40 ) or CEM ( n = 40 ) groups . After coronal pulp removal , the remaining radicular pulp was covered with an appropriate bio material ; the teeth were then permanently restored . Clinical /radiographic success/failures were blindly evaluated at 6- , 12- and 24-month follow-ups . STATISTICS the recorded data were analyzed with McNemar test and GEE . RESULTS A total of 36 , 33 and 35 patients were available for 6- , 12- and 24-month follow-ups , respectively . At the 12-month follow-up only one and three teeth in the CEM and MTA groups had pathologic external root resorption , respectively . The resorbed teeth were then missed due to extraction /exfoliation at the 24-month follow-up ; all other treated teeth were sign/symptom-free . Overall , clinical and radiographic outcomes in both MTA/CEM groups were comparable at the three follow-ups without significant differences . Time had no significant effect on the success . CONCLUSION MTA and CEM demonstrated favourable treatment outcomes for pulpotomy of carious primary molars ; CEM may be an effective pulp dressing bio material
Vital permanent teeth with cariously exposed pulp can be treated successfully with vital pulp therapy .
INTRODUCTION This systematic review aims to illustrate the outcome of vital pulp therapy , namely  direct pulp capping , partial pulpotomy , and full pulpotomy  , in vital permanent teeth with cariously exposed pulp .