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This study aimed to evaluate the histological success of pulpotomy in primary molars using white mineral trioxide aggregate (WMTA) mixed with 2.25% sodium hypochlorite (NaOCl) gel and to evaluate in vitro its physical and chemical properties. The study had a clinical stage and an in-vitro stage. The clinical study was conducted with 24 patients aged 8–10 years. It was a randomized controlled trial to perform a histologic evaluation of pulp response following pulpotomy. Primary first molars were randomly assigned in split mouth model to control group—WMTA + distilled water (DW) or experimental group – WMTA + NaOCl gel. Teeth were extracted after 7, 30 or 90 days and submitted to histological analysis. The second stage was an in-vitro study to evaluate the physical and chemical properties of the two materials tested. SEM and EDX analyses and pH level evaluations were performed after 24 h and 28 days. The histological findings revealed that while WMTA + NaOCl gel group showed better odontoblastic integrity (P < 0.05), WMTA + DW group had more favorable outcomes in dentin bridge formation and pulp calcification (P < 0.05). Pulp tissue hemorrhage and pulp fibrosis were similar between them (P > 0.05). Regarding materials' in vitro evaluation, the pH level indicated a higher initial pH for the WMTA + NaOCl gel group, which equalized after 28 days. SEM analysis initially showed a less homogeneous surface for WMTA + NaOCl gel, but it became similar after 28 days. EDX analysis indicated higher calcium and silicon percentages in the WMTA + NaOCl gel group initially, which increased in both groups after 28 days. Adding 2.25% NaOCl gel to WMTA enhanced odontoblastic integrity in both the short and medium term. In addition, it had a similar chemical composition, surface morphology, and alkalinity when compared to WMTA + DW mixture. [ABSTRACT FROM AUTHOR]

Background: Toothache is a debilitating condition, often with mild to excruciating pain, swelling, eating difficulties and insomnia. This study aims to delineate the profiles of patients seeking emergency dental care, focusing on the diagnosis, treatment, and outcomes following non-surgical root canal treatment. Methods: This prospective cohort study was conducted from 2012 to 2021 at the Section for Endodontics, Department of Clinical Dentistry, University of Bergen, Norway. A total of 281 emergency patient forms were analyzed. Data registered included patient demographics, dental history, chief complaints, medications used, diagnostic results, treatments provided and outcome. Results: A total of 272 patients (272 teeth) were included in the study. Pain was the predominant complaint (98.5%), where only 57.4% of the patients managed to localize pain to a specific tooth. The mean age of patients was 51.2 years with no significant gender differences. The maxillary right first molar (15.4%) was the most frequent tooth needing treatment. The majority of the patients had experienced pain for three days before they attended the emergency appointment. The most frequently used drug for pain management was paracetamol which was stated to have little effect. Teeth that needed endodontic treatment often had restorations rather than caries. The most frequent diagnoses were pulpitis (26.8%) followed by necrotic pulp (25.4%) and previously root filled teeth (22.8%). Root canal treatment was performed on 60% of the teeth and a success rate of 95% was registered at one-year recall. Conclusions: There was no singular diagnostic cause leading patients to seek an emergency appointment, highlighting the necessity of a thorough diagnostic procedure. Over the counter pain medications have little effect on alleviating dental pain, often resulting in desperate measures of self-medication. 60% of the teeth needing emergency treatment had previous coronal restorations such as fillings or crowns, indicating that conservative treatment does not appear to fully protect against future pulpal disease. The good prognosis of root canal treatment for teeth with acute symptoms supports recommending dentists to attempt root canal treatment rather than opting for tooth extraction. [ABSTRACT FROM AUTHOR]

Background: A Partial pulpotomy technique is an alternative choice of treatment for immature permanent teeth with exposed vital pulps. This study aimed to compare the histopathological pulpal response of the primary teeth of puppies after partial pulpotomy and full pulpotomy using mineral trioxide aggregate (MTA). Materials and methods: 72 primary premolars from experimental puppies aged 6–8 weeks were equally divided into test and control groups, as MTA partial pulpotomy (MTA-PP) and MTA full pulpotomy (MTA-FP). After 60 days, the teeth were extracted and examined histologically. The specimens were assessing the extent and intensity of inflammatory response (acute or chronic), necrosis, fibrosis, calcific bridge (presence or absence), pulp calcification, and pathological root resorption. Results: The Inflammation intensity was lower (2.8%) in MTA-PP than in MTA-FP (16.7%) (P = 0.004). MTA-FP also had a significantly higher percentage of localized (27.8%) and diffuse (11.1%) necrosis (P = 0.014), whereas both groups (P = 0.290) had an equal fibrosis degree. A calcific bridge was observed in 72.2% of cases. Meanwhile, pathological internal root resorption was more evident in MTA-FP (63.9%) than in MTA-PP (19.4%) (P <0.0001). Conclusion: Partial MTA pulpotomy procedure demonstrated promising histological findings that can be applied to vital-pulp therapy in primary teeth. [ABSTRACT FROM AUTHOR]

Background: Dental caries is one of the most prevalent dental illnesses in children. Untreated severe caries can damage teeth, requiring pulpotomy to save them. Objective: To evaluate the clinical success rate of treatments involving pulpotomies + IRM (Intermediate Restorative Material, composed of reinforced zinc oxide–eugenol polymers) + preformed metal crowns (PMCs) in primary teeth of children treated at a public university in Mexico. Materials and Methods: A cross-sectional ambispective study was conducted on children aged 10 years or younger, treated at a public university in Mexico. A total of 1281 medical records from February 2018 to June 2023 were reviewed, yielding a sample of 199 children treated with pulpotomy + IRM + PMC. Information was collected via telephone interviews with parents/caregivers to inquire about any symptoms following the pulpotomy and metal crown treatments. Success was defined as the absence of pain, inflammation, or infection. Results: During the study period, the number of teeth treated with pulpotomy + IRM + PMC was 414, with follow-ups ranging from 6 to 69 months. Most participants were girls (54.3%), while 45.7% were boys. Out of the 167 pulpotomy + IRM + PMC treatments included in the study, the clinical success rate was 98.2%. Conclusions: The clinical success rate of primary teeth treated with pulpotomy + IRM + PMCs was high, close to 100%, based on evidence and symptom reports from parents/caregivers. It would be beneficial to implement its use in public health institutions in countries such as Mexico. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Success of pulpotomy of primary teeth depends on biological and cytotoxic effects of pulp capping agents. Mineral trioxide aggregate (MTA), Biodentine, calcium enriched mixture (CEM) cement, and ferric sulfate (FS) are among the commonly used pulp capping agents (PCAs) for pulpotomy, and their successful application has been previously evaluated. Purpose: This study aimed to compare the cytotoxicity of PCAs against mesenchymal stem cells isolated from human exfoliated deciduous teeth (SHEDs). Materials and Method: In this in vitro study, SHEDs were exposed to MTA, Biodentine, CEM cement, and FS for 24 and 72 hours. The methyl thiazolyl tetrazolium (MTT) assay was performed for five different concentrations of PCAs after 24 and 72 hours of exposure. Data were analyzed by ANOVA. Results: Generally, the biocompatibility increased by reduction in concentration. All tested concentrations showed higher biocompatibility at 72 hours compared with 24 hours (p< 0.0001). Comparison of cytotoxicity of different biomaterials revealed no significant difference at any time point (p> 0.05). Conclusion: In general, the cytotoxicity of MTA, Biodentine, CEM cement, and FS was comparable, with no significant difference. Cytotoxicity decreased over time and by a reduction in concentration of biomaterials. MTA and Biodentine showed maximum biocompatibility followed by FS, and CEM cement. [ABSTRACT FROM AUTHOR]

The present study aimed to compare the clinical and radiographic success rates of Formocresol (FC), Portland Cement (PC), and NeoMTA Plus in primary molar pulpotomy. Ninety-six primary molars in ninety-six children aged 3‒9 years were randomly assigned to FC, PC, and NeoMTA Plus groups. Radiographic and clinical follow-up evaluations were performed at six and twelve months. After six and twelve months, clinical success rates were 100% in the three groups. The radiographic success rates in the 6-month follow-up were 96.7 and 96.7% in the FC and PC groups and 100% in the NeoMTA Plus group. At 12 months, radiographic success rate was 93.8, and 93.8% in the FC and PC groups and 96.9% in the NeoMTA Plus group. There were no significant differences between the three groups at all follow-up evaluations. NeoMTA Plus showed highest success rate, clinically and radiographically. PC and NeoMTA Plus can be considered as an alternative to FC. [ABSTRACT FROM AUTHOR]

Background: Children with hearing impairment (HI) face communication challenges during dental procedures due to hearing loss. Studies suggest that distraction techniques, like virtual reality (VR), can effectively divert their focus from stressful stimuli, resulting in a more comfortable dental experience. The present study aims to assess the effectiveness of distracting children with moderate to severe (HI) with virtual reality glasses that show cartoons in sign language during pulpotomy treatment compared to conventional management techniques. Methods: Forty children aged five to seven participated in a randomized controlled parallel two-arm clinical trial—the type of behavioral management employed determined which two groups children were randomly placed into. Group I (Study group) used virtual reality glasses as a diversion, while Group II (Control group) used the conventional behavior management approach. Local anesthesia was administrated, and a pulpotomy procedure was performed on the selected tooth, followed by stainless steel crown restoration (SSC). There were three methods used to assess dental anxiety before and after the procedure: the physiological method, which used heart rate (HR); the objective measure, which used the Venham Clinical Anxiety Scale (VCAS); and the subjective measure, which used the modified Facial Affective Scale (FAS). An independent t-test was employed for HR analysis of the difference between the groups as a continuous variable. The Pearson Chi-square test assessed differences between groups for categorical variables, such as (VCAS) (FAS). Results: No significant differences were found in mean (HR) or (VCAS) between the two groups throughout the procedures: during local anesthesia (p = 0.659, 0.282), pulpotomy (p = 0.482, 0.451), and stainless steel crown preparation (p = 0.090, 0.284). Anxiety levels by (FAS) remained statistically comparable between the two groups before and after the procedures (p = 0.507, 0.749), respectively. Conclusions: The use of VR glasses revealed no significant advantages in managing children with HI during the dental visit compared to the conventional method of child behavior management. Trial registration: The trial was prospectively enrolled on 11/11/2023 under the identification number NCT06153823 on ClinicalTrials.gov. [ABSTRACT FROM AUTHOR]

Background: Pulpotomy is a widely recommended treatment for deep caries and reversible pulpitis in primary teeth. However, there is a significant lack of large-scale clinical studies evaluating the long-term efficacy of pulpotomy in primary molars, especially in studies with follow-up periods extending beyond a two years. Aim: This study aimed to evaluate the long-term efficacy of mineral trioxide aggregate (MTA) and iRoot BP Plus for pulpotomy in primary molars performed under general anesthesia and to investigate factors influencing the success rate. Methods: In this retrospective study, a total of 942 primary molars from 422 children who met the inclusion criteria underwent pulpotomy. Propensity score matching method (PSM) was used to match the MTA and iRoot BP Plus groups in a 1:1 ratio based on covariates. Efficacy was assessed using the Zurn & Seale criteria. Kaplan-Meier survival analysis and Cox proportional hazards model were performed to analyze the outcomes. Results: PSM resulted in 266 pairs of matched teeth from 532 teeth of 291 children (mean age: 4.64 ± 1.07 years, ranging from 2 to 8 years). Long-term clinical and radiographic evaluations revealed higher success rates for iRoot BP Plus (24-month: 99.54%/97.25%; 36-month: 97.22%/95.83%) compared to MTA (24-month: 94.76%/95.29%; 36-month: 92.50%/91.25%). Survival analysis indicated a statistically significant difference between two groups (P = 0.0042). Age, gender, tooth position, and decayed tooth surface showed no significant impact on pulpotomy success, whereas the choice of pulp capping materials significantly influenced the outcome (HR [95% CI]=0.3745[0.1857-0.7552], P = 0.006). Conclusion: Clinical and radiographic evaluations support the use of iRoot BP Plus for pulpotomy in primary molars. [ABSTRACT FROM AUTHOR]

Introduction: Vital pulp therapy (VPT) aims to preserve dental pulp after injury and has gained significant popularity due to advancements in materials and understanding of pulp biology. While bibliometric analyses are common in various fields, none have been conducted specifically for the 100 most-cited articles on VPT. Materials and Methods: This bibliometric study analyzed the 100 most-cited VPT papers using data from Web of Science (WoS-CC), Scopus, and Google Scholar. Articles were manually reviewed to extract key bibliometric data, including titles, citation counts, citation density, authorship, country of origin, publication year, journal, study design, and VPT type. Results: The articles collectively received 19,782 citations, with the oldest from 1966 and the most recent from 2019, having 803 and 104 citations, respectively. Key journals included the Journal of Endodontics , International Endodontic Journal , and Dental Materials. Review articles were the predominant study design, followed by clinical, laboratory, and basic research studies. Eight of the top 20 articles focused on the properties of mineral trioxide aggregate (MTA). Torabinejad and Parirokh were notable contributors before 2010, while Duncan, Bjørndal, and Simon were prominent after 2010. VPT research has increased significantly post-2010, with a notable shift in focus from early studies on calcium hydroxide to more recent studies on MTA's biocompatibility and its use as a pulp capping agent. Conclusion: This analysis provides a comprehensive list of the top 100 cited VPT articles, offering valuable insights for researchers, students, and clinicians. The study highlights key trends and influential contributions in the field of VPT research. [ABSTRACT FROM AUTHOR]

Background: Prefabricated Zirconia Crowns (PZCs) are increasingly preferred for restoring primary teeth due to their esthetic appeal and retention. However, their rigid, unmodifiable design requires precise tooth preparation, often leading to aggressive reduction and potential pulp exposure. Pulpotomy, a standard treatment for reversible pulpitis and mechanical pulp exposure, is sometimes employed before PZCs. While pulpotomy is not routinely performed, its use raises important considerations about the interplay between restorative procedures and pulp therapy in pediatric dentistry, particularly regarding the long-term restoration outcomes of PZCs. Purpose: This study aimed to investigate the impact of pulpotomy on the success rate of PZCs. Methods: We examined 81 anterior upper primary teeth treated with PZCs in children aged 2–5 years over a two-year period. Cases were divided into groups with and without pulpotomy. Follow-ups occurred at 6-month intervals, assessing clinical and radiographic outcomes. Analyses were performed using SPSS 25.0 software. The statistical significance was p < 0.05. Results: A total of 81 anterior primary teeth were included. Chi-square analysis showed no association between pulp therapy and PZC success (χ2 = 0.051, p = 0.822). The Kaplan–Meier survival analysis revealed comparable survival curves and the log-rank test showed no statistically significant difference in survival time between pulpotomy-treated and untreated groups (χ2 = 0.051, p = 0.821). Conclusions: Pulpotomy did not significantly affect the success rate of PZCs within 2 years. [ABSTRACT FROM AUTHOR]

Abstract This study aimed to evaluate the histological success of pulpotomy in primary molars using white mineral trioxide aggregate (WMTA) mixed with 2.25% sodium hypochlorite (NaOCl) gel and to evaluate in vitro its physical and chemical properties. The study had a clinical stage and an in-vitro stage. The clinical study was conducted with 24 patients aged 8–10 years. It was a randomized controlled trial to perform a histologic evaluation of pulp response following pulpotomy. Primary first molars were randomly assigned in split mouth model to control group—WMTA + distilled water (DW) or experimental group – WMTA + NaOCl gel. Teeth were extracted after 7, 30 or 90 days and submitted to histological analysis. The second stage was an in-vitro study to evaluate the physical and chemical properties of the two materials tested. SEM and EDX analyses and pH level evaluations were performed after 24 h and 28 days. The histological findings revealed that while WMTA + NaOCl gel group showed better odontoblastic integrity (P 0.05). Regarding materials’ in vitro evaluation, the pH level indicated a higher initial pH for the WMTA + NaOCl gel group, which equalized after 28 days. SEM analysis initially showed a less homogeneous surface for WMTA + NaOCl gel, but it became similar after 28 days. EDX analysis indicated higher calcium and silicon percentages in the WMTA + NaOCl gel group initially, which increased in both groups after 28 days. Adding 2.25% NaOCl gel to WMTA enhanced odontoblastic integrity in both the short and medium term. In addition, it had a similar chemical composition, surface morphology, and alkalinity when compared to WMTA + DW mixture.

Abstract Background Toothache is a debilitating condition, often with mild to excruciating pain, swelling, eating difficulties and insomnia. This study aims to delineate the profiles of patients seeking emergency dental care, focusing on the diagnosis, treatment, and outcomes following non-surgical root canal treatment. Methods This prospective cohort study was conducted from 2012 to 2021 at the Section for Endodontics, Department of Clinical Dentistry, University of Bergen, Norway. A total of 281 emergency patient forms were analyzed. Data registered included patient demographics, dental history, chief complaints, medications used, diagnostic results, treatments provided and outcome. Results A total of 272 patients (272 teeth) were included in the study. Pain was the predominant complaint (98.5%), where only 57.4% of the patients managed to localize pain to a specific tooth. The mean age of patients was 51.2 years with no significant gender differences. The maxillary right first molar (15.4%) was the most frequent tooth needing treatment. The majority of the patients had experienced pain for three days before they attended the emergency appointment. The most frequently used drug for pain management was paracetamol which was stated to have little effect. Teeth that needed endodontic treatment often had restorations rather than caries. The most frequent diagnoses were pulpitis (26.8%) followed by necrotic pulp (25.4%) and previously root filled teeth (22.8%). Root canal treatment was performed on 60% of the teeth and a success rate of 95% was registered at one-year recall. Conclusions There was no singular diagnostic cause leading patients to seek an emergency appointment, highlighting the necessity of a thorough diagnostic procedure. Over the counter pain medications have little effect on alleviating dental pain, often resulting in desperate measures of self-medication. 60% of the teeth needing emergency treatment had previous coronal restorations such as fillings or crowns, indicating that conservative treatment does not appear to fully protect against future pulpal disease. The good prognosis of root canal treatment for teeth with acute symptoms supports recommending dentists to attempt root canal treatment rather than opting for tooth extraction.

Abstract Introduction Both pulpotomy and pulpectomy are indicated in deciduous teeth with carious pulp exposure. Pulpotomy is recommended for treating carious pulp exposure in primary molars with the development of dental biomaterials. However, it is difficult to determine the severity of pulpitis as children frequently have difficulty communicating their clinical symptoms and there is no objective diagnostic method to assess pulpal status. Thus, therapeutic interventions for deciduous teeth with carious pulp involvement are controversial in clinical applications. This study compared the clinical and radiographic survival time of iRoot BP Plus pulpotomy and Vitapex pulpectomy in treating extremely deep caries with carious pulp exposure in deciduous molars under general anaesthesia. Methods The 876 deciduous teeth in patients aged 3 to 6 years diagnosed with extremely deep caries were categorised into Group A (iRoot BP Plus pulpotomy) and Group B (Vitapex pulpectomy) based on treatment methods in this retrospective cohort study. The Kaplan-Meier survival curves were used to compare the survival rates and time between the groups. The Cox proportional hazards model was used to evaluate the factors associated with success. Results 876 primary molars were collected, including Group A (504) and Group B (372). The clinical and radiographic survival time in Group A (54.394 ± 1.388(months) and 48.978 ± 1.413(months)) were significantly higher than that in Group B (47.867 ± 0.956 (months) and 38.834 ± 0.981 (months)) (P

Objective To explore the long-term clinical effect of Theracal LC on complicated crown fracture of immature permanent teeth. Methods A total of 33 teeth (13 males,15 teeth; 16 females, 18 teeth) from 29 adolescent patients with complicated crown fracture were collected. In this randomized clinical trial, all the samples were divided into two groups depending on the different pulp capping materials: the experimental group-Theracal LC(n=17) and the control group-MTA(n=16), with the same contralateral or adjacent teeth as blank control group. The treated teeth were evaluated clinically and radiographically at 3, 6, 12, 24, 36, 48 months. Results During the 4-year follow-up, clinical symptoms of all the treated teeth in both groups improved and disappeared. At 6 months, the clinical success rate of both groups was 100%. The clinical success rate was 93.7% at 12 months in the MTA group. The clinical success rates of Theracal LC group at 12 months and 24 months were 94.1% and 88.2%, respectively. There was no statistical difference between the groups in clinical efficacy(P>0.05). The samples of MTA group went black, while Theracal LC group had no discoloration. The formation rate of early-formed dentine bridge in Theracal LC group was relatively faster than that in MTA group. The dentine bridge could be seen in all samples of both groups in the long term. The dentine bridges in Theracal LC group had complex morphology, while the linear uniform was mostly seen in MTA group. Conclusion As a pulp capping agent, Theracal LC has good clinical efficacy and biosafety,and can be used as one of the substitutes for MTA.

Objective This clinical study was aimed to investigate the clinical and radiographic outcomes of NeoPutty MTA® (Nusmile), a novel mineral trioxide aggregate (MTA) pulpotomy material, in primary teeth of children aged 4–6 years. Methods An in vivo study was done in children aged 4–6 years old. A total of 50 primary second molar teeth were included in the study, with 25 of them undergoing treatment with formocresol (FC) and 25 receiving treatment with NeoPutty MTA®. The subjects were divided into two groups for treatment: the first group received a treatment involving a 1:5 dilution of Buckley’s FC. The second group, however, underwent treatment with NeoPutty MTA®. This study employs a meticulous approach to evaluate the impact of different treatments on a significant number of molar teeth, using FC and NeoPutty MTA® as the respective treatment methods. The demographics of the subject pool are well-documented, comprising a balance of male and female participants. The technique employed for pulp removal and the subsequent management of bleeding are outlined, underscoring the thoroughness of the process. Results At 12 months, the NeoPutty MTA® pulpotomy group showed a significantly higher success rate clinically (96%) compared to the FC group (72%) (P < 0.05), but radiographically although NeoPutty MTA® was better (92%) than FC (82%), it was not statistically significant. NeoPutty®-treated teeth exhibited no signs of pain or discomfort and demonstrated better pulp vitality compared to the FC group. Conclusion NeoPutty MTA® demonstrated superior clinical success rates and better radiographic outcomes compared to traditional FC pulpotomy.

Abstract Background The aim of this study was to compare postoperative pain following total pulpotomy (TP) and root canal treatment (RCT) in mature molar teeth with irreversible pulpitis. To compare the traditional pulpitis classification system with the Wolters system in evaluating postoperative pain. Methods Eighty mandibular molars with irreversible pulpitis were included and classified according to the Wolters (moderate/severe pulpitis). The teeth were randomly assigned to two groups (RCT or TP). RCT was performed following standardized protocols. TP was performed to the level of the canal orifices, and hemostasis was achieved with 2.5% sodium hypochlorite. A 3 mm layer of MTA was placed as the pulpotomy material. The teeth were restored with glass ionomer cement followed by composite. Pain scores were recorded preoperatively and, at 6, 12, 24, 48, and 72 h and 7 days after the interventions. The data were statistically analyzed using the Mann-Whitney U test, the Friedman test, the Wilcoxon signed-rank test, and the Spearman’s correlation test. The significance level was set at 0.05. Results Sixty-four patients were analyzed at the one-week follow-up and all were diagnosed as irreversible pulpitis according to the AAE; 22 teeth were classified as moderate and 42 teeth were classified as severe pulpitis according to Wolters. There was no significant difference between TP and RCT in pain scores in moderate pulpitis patients (p > 0.05). There was a significant difference between TP and RCT at 24 and 72 h of severe pulpitis; higher pain scores were observed in the RCT (p

Abstract This review aims to comprehensively explore calcium-enriched mixture (CEM) cement as a crucial biomaterial in dentistry/endodontics. With its growing clinical relevance, there is a need to evaluate its composition, chemical/physical/biological properties, clinical applications, and future perspectives to provide clinicians/researchers with a detailed understanding of its potential in endodontic procedures. Through systematic analysis of available evidence, we assess the advantages/limitations of CEM cement, offering valuable insights for informed decision-making in dental/endodontic practice. Our findings highlight the commendable chemical/physical properties of CEM cement, including handling characteristics, alkalinity, color stability, bioactivity, biocompatibility, sealing ability, and antimicrobial properties. Importantly, CEM cement has shown the potential in promoting regenerative processes, such as dentinogenesis and cementogenesis. It has demonstrated successful outcomes in various clinical applications, including vital pulp therapy techniques, endodontic surgery, open apices management, root resorption/perforation repair, and as an orifice/root canal obturation material. The efficacy and reliability of CEM cement in diverse clinical scenarios underscore its effectiveness in endodontic practice. However, we emphasize the need for well-designed clinical trials with long-term follow-up to further substantiate the full potential of CEM cement. This review serves as a robust reference for researchers/practitioners, offering an in-depth exploration of CEM cement and its multifaceted roles in contemporary dentistry/endodontics.

Abstract Background Pulpotomy is a crucial method to preserve primary teeth until natural exfoliation. This study aimed to evaluate the clinical and radiographic outcomes of pulpotomy with iRoot BP Plus in primary molars and to explore the association between hemostasis time and these outcomes. Methods Primary molars that underwent iRoot BP Plus pulpotomy and were followed for at least 12 months were selected for this study. Clinical and radiographic data were collected, and the success rate was analyzed in relation to factors such as hemostasis time, tooth type, and arch type. The tests of significance used were the chi-square test, Fisher’s exact test, or Kruskal-Wallis test. Statistical significance was set at P 0.05). Conclusions Pulpotomy using iRoot BP Plus in primary molars achieved favorable results. The hemostasis time may not significantly impact the outcomes of pulpotomy using iRoot BP Plus in primary molars.

Abstract This study aims to investigate the effect of Mineral Trioxide Aggregate (MTA), a bioactive endodontic cement, and Concentrated Growth Factor (CGF), a second-generation autologous growth factor, on pulpotomy-induced pulp inflammation. The study utilized the maxillary anterior central teeth of thirty-six young male Sprague Dawley rats. Forty-eight teeth were randomly assigned to two groups (12 rats/group; 24 teeth/group) based on the capping material (MTA or CGF). Subsequently, two subgroups (MTAG and CGFG) were formed per group (12 teeth/group) based on the time following pulpotomy (2-weeks and 4-weeks). The central teeth of the 12 animals assigned to the control group (CG) were not manipulated in any way, both in the 2-week group and in the 4-week group. Tissue samples extracted from rats at the end of the experiment were stained with H&E for histopathological analysis. For immunohistochemical analysis, primary antibodies for TNF-α and NF-kβ/65 were incubated. Data obtained from semi-quantitative analysis were assessed for normal distribution using Skewness-Kurtosis values, Q-Q plot, Levene’s test, and the Shapiro-Wilk test on statistical software. A P value

Background: Various dressing materials have been evaluated for pulpotomy of primary teeth. However, an ideal pulp dressing material has not been identified yet. This systematic review investigated the effectiveness of TheraCal compared to Formocresol in pulpotomy of primary teeth. Materials and methods: This research was conducted in the form of a secondary study, with a systematic search of texts until 2023 in Scopus, Web of Science, PubMed and Google Scholar databases. The articles were selected based on the inclusion and exclusion criteria and, finally the search results were reported in the PRISMA chart. The quality of the studies was evaluated based on the NIH checklist. The extracted information was entered into Stata17 software. Heterogeneity was evaluated using Cochran’s chi-square test and I2 statistics. Egger’s tests were used to detect publication bias. Results: After removing duplicate articles and articles that did not meet the inclusion criteria, 4 studies were selected for qualitative analysis. The odds’ ratio of success rate between Formocresol and TheraCal pulpotomy for absence of the pain, abscess, Mobility, internal root resorption and bone radiolucency was obtained 1.12 (95 % CI: 0.32, 3.85, P = 0.86), 0.47 (95 % CI: 0.1, 2.14, P = 0.33), 0.82 (95 % CI: 0.21, 3.21, P = 0.78), 0.89 (95 % CI: 0.3, 2.67, P = 0.84), and 1.96 (95 % CI: 0.68, 5.62, P = 0.21) respectively. Conclusion: The study results revealed that there was no significant difference in clinical and radiographic success between pulpotomy with TheraCal and Formocresol.

The decision making process for managing irreversible pulpitis in permanent teeth often involves choosing between pulpotomy and root canal treatment, with clinicians exercising discretion. This systematic review and meta-analysis aim to evaluate the efficacy of calcium silicate based pulpotomy in treating symptomatic permanent teeth with irreversible pulpitis. A comprehensive search across PubMed, Google Scholar, and SCOPUS databases yielded 482 articles. From this pool, 169 articles underwent further scrutiny. Following data filtration, presentation, and analysis, a meta-analysis was conducted using RevMan 5 software. Eleven articles were ultimately selected based on predefined inclusion and exclusion criteria. This meta-analysis revealed that calcium silicate based pulpotomy, employed in treating irreversible pulpitis cases, exhibited notable success rates ranging from 75% to 90% over a period of 15 years across most of the included studies. The majority of studies integrated into this systematic review reported successful outcomes for teeth with symptomatic irreversible pulpitis undergoing pulpotomy with the utilization of calcium silicate. Nonetheless, further research is necessary to delineate the precise roles of calcium silicate based pulpotomy in managing this condition.

Background: Vital pulp therapy (VPT) is recommended as an alternative treatment to root canal therapy (RCT) for management of teeth with carious pulp exposure. This randomized clinical trial aimed to compare the outcomes and postoperative pain, and to evaluate the time and cost after full pulpotomy (FP) and RCT in mature molar teeth with irreversible pulpitis (IP). Methods: A total of 160 mature molar teeth with IP were randomly divided into two treatment groups. The FP group (test group) was treated with FP using iRoot BP Plus by an endodontist, the RCT group (control group) was treated with RCT using iRoot SP as sealer by the same endodontist. Pain was recorded preoperatively and daily until day 7 postoperatively. The treatment time and cost were recorded. Clinical and radiographic assessments were collected, and pulp sensibility tests were done by electric pulp test (EPT) at 3-, 6-, 12- month postoperatively. Data were analyzed through chi-square test, Mann-Whitney U test, Fisher exact and independent t test. Results: FP and RCT had comparable success rates (Clinical, 97.3% vs. 98.6%; radiographic, 93.3% vs. 94.6%) (P > 0.05). Pain levels decreased over time from day 1 to day 7 postoperative in both groups, and the FP group had larger reductions in pain intensity than RCT at day 1 (P < 0.05). In the FP group, there were 5, 3 and 3 unresponsive teeth with EPT at 3-, 6- and 12- month follow-ups, respectively. The treatment time and cost in the FP group were significantly lower than in the RCT group (P < 0.05). Conclusions: FP could be an appropriate alternative treatment for management of mature teeth with IP in short follow-up. Trial registration: The trial was registered in Chinese Clinical Trial Registry (ChiCTR2200063380 at 05/09/2022). [ABSTRACT FROM AUTHOR]

Background: While the effect of biomaterials covering the pulp tissue is considered in the success of pulpotomy treatment, the level of pulpal inflammation is still very important for treatment success. The aim of this study was to compare IL-6 and IL-8 levels, known as good indicators of pulpal inflammation, with a new biomarker, presepsin, and to evaluate the impact of biomarker levels along with the pulp capping agents used in the treatment on the one-year success of pulpotomy treatment. Methods: The study included 120 primary second molar teeth with pulpotomy indications from 75 children. To determine the pulpal inflammation status, pulpal bleeding samples were taken during treatment, and the levels of IL-6, IL-8, and presepsin were measured. During the pulpotomy treatment, MTA, NeoMTA™, and Biodentine™, and ZOE were randomly applied to groups of thirty teeth each. Patients were monitored for a period of 12 months post-treatment. Results: IL-8, IL-6, and presepsin levels were significantly higher in teeth with pathology (p < 0.001). Biomarker levels were found to be higher in the NeoMTA and Biodentine groups, but this did not result in a statistically significant difference. (p > 0.05) Following pulpotomy treatment, the most successful material groups in order were MTA, ZOE, NeoMTA™, and Biodentine™. Conclusion: Presepsin may be a usable indicator in predicting the level of inflammation. At the end of the one-year follow-up of pulpotomy treatment, more pathology was observed in the NeoMTA and Biodentine groups, where biomarker levels were higher, while no pathology was found in the MTA group, where biomarker levels were lower. Trial registration: NCT06398327/ 20,240,503. [ABSTRACT FROM AUTHOR]

Pulpotomy is the total amputation of coronal pulp tissue and subsequent placement of a pulpotomy agent over the root canal orifices, followed by a coronal seal. The most suitable pulpotomy agent for successful treatment outcomes remains controversial. To evaluate and compare the clinical and radiographic success of calcium hydroxide (CH) and Biodentine (BD) in primary tooth pulpotomy at 6 and 12 months. An automatised search of the PubMed-Medline, Web of Science, and SCOPUS electronic databases was performed to identify scientific articles on primary tooth pulpotomies with either calcium hydroxide (CH) or Biodentine (BD) as a pulpotomy agent, published until January 2024. The software used for meta-analysis was R 4.3.1 (R Core Team, 2023). Of the 594 potentially eligible articles, 14 met the inclusion criteria: seven articles on CH pulpotomy and seven articles on BD pulpotomy with 6- and 12-months of follow-up. The meta-analysis concluded a mean clinical success rate of 91.8 % at 6 months and 79.0 % at 12 months for the CH group, and 99.2 % at 6 months and 98.8 % at 12 months for the BD group. In terms of the mean radiographic success, the CH group achieved 74.2 % at 6 months and 63.7 % at 12 months, whereas the BD group achieved 99.4 % at 6 months and 98.4 % at 12 months. In comparison, the meta-analysis concluded a marginally significant difference in clinical success in favour of the BD group at 6 months (p = 0.091). At 12 months, clinical success was significant in the BD group (p = 0.023). Regarding radiographic success, a significant difference in favour of the BD group was observed at 6 (p = 0.008) and 12 months (p < 0.001). BD showed significantly higher clinical and radiographic success than CH in pulpotomy. [ABSTRACT FROM AUTHOR]

Background and Aim: This study aims to evaluate the efficacy of different endodontic irrigants employed in the lesion sterilization and tissue repair (LSTR) technique. Methods: Forty children aged 4–8 years having at least one primary molar with irreversible pulpitis/pulpal necrosis indicated for pulpectomy were included. Participants were randomly divided into three test groups (Group A, B, and C) and one control group (Group D). After caries excavation using a spoon excavator, superficial pulp was removed under topical anesthesia in all groups. Following this, pulpal floor was irrigated using different endodontic irrigants in each group: Group A – 20% propolis, Group B – 2% sodium hypochlorite, Group C – 2% chlorhexidine gluconate, and Group D (control) – saline. Alternate 3-Mix (triple antibiotic paste containing metronidazole, ciprofloxacin, and amoxicillin) was then placed over the pulpal floor and the teeth were restored with glass ionomer cement followed by stainless steel crown. Patients were recalled at follow-up periods up to 18 months for clinical and radiographic evaluation. Repeated-measures ANOVA test, Chi-square test, and independent t -test were used for statistical analysis. Results: Clinical success was achieved in all treated teeth, with the results showing statistical significance (P < 0.05). In addition, Group C showed best clinical results. Statistically significant results (P < 0.05) were obtained in reduction in size of furcation radiolucency, with Group B showing the best results compared to other groups. Statistically significant results (P < 0.05) were obtained in terms of rate of root resorption in all teeth, with Group C showing least resorption compared to other groups. Conclusions: The use of endodontic irrigant before the placement of alternate 3-Mix is an effective step for the improved success of LSTR technique in primary teeth, with chlorhexidine showing the best success rate. [ABSTRACT FROM AUTHOR]

Introduction: Untreated tooth decay in mature permanent dentition is a prevalent global issue, affecting 34.1% of people with 2.5 billion cases annually. Extensive decay often leads to irreversible pulpitis, characterized by pulp inflammation and pain. Pulpectomy, the standard treatment, involves complex procedures with potential complications. Modern endodontics favors minimally invasive treatment such as pulpotomy, which preserves pulp vitality. This study aims to compare the clinical as well as radiographic outcomes of different pulpotomy agents: Biodentine, mineral trioxide aggregate (MTA), Bio-C repair, and Endosequence Bio-ceramic root repair material (BCRRM) in mature permanent molars. Methodology: This single-blind, single-center study involved 80 participants randomly assigned to four groups, each receiving one of the biomaterials. Ethical approval was obtained. Participants aged 14–60 years with symptomatic irreversible pulpitis were selected. Pulpotomy procedures were performed, and follow-up evaluations occurred at 24 h, 1 week, 4 weeks, 3, 6, and 12 months. Clinical success was measured by the absence of pain, sensitivity, and tenderness. Radiographic evaluation used the periapical index (PAI) scoring system. Results: Pulpotomy significantly reduced postoperative pain in all groups. Endosequence BCRRM showed the maximum pain reduction at 24 h with a statistically significant difference from all the groups (at 1% probability level), followed by Bio-C repair, Biodentine, and MTA. At 1 week, Bio-C repair led in pain reduction with statistically nonsignificant results. All groups reported no pain at 3, 6, and 12 months. Endosequence BCRRM had the highest improvement in periapical findings at 1 year. Sensitivity to hot and cold improved significantly in all groups, with Endosequence BCRRM performing best. Conclusion: Endosequence BCRRM provided the best overall outcomes, emphasizing the importance of material choice in pulpotomy treatments. Further research on biomaterials' long-term clinical and radiographic outcomes is needed to enhance treatment efficacy. [ABSTRACT FROM AUTHOR]

Introduction: This review evaluates the effectiveness of treatment modalities for immature teeth with pulp necrosis, focusing on calcium hydroxide (CH) and mineral trioxide aggregate (MTA) apexification, as well as regenerative endodontic treatments (RETs). Recent advancements and clinical outcomes are highlighted. Materials and Methods: A comprehensive search of MEDLINE (PubMed), Embase, Cochrane Library, Scopus, and grey literature was conducted from inception to July 2024. Systematic reviews and meta-analyses (SR/MAs) assessing apexification and RET outcomes in immature teeth with pulp necrosis were included. Studies were selected based on predefined criteria, and data on study design, interventions, and outcomes were extracted. Methodological quality was evaluated using the AMSTAR-2 tool. Results: 31 SR/MAs were included. The quality ranged from critically low to low, except one rated as high. MTA apexification was more effective than CH for faster apical barrier formation, though overall success rates were similar. MTA is preferred for its efficiency, but standardized protocols are needed, and tooth discoloration was noted as a potential complication. RET generally outperforms apexification in root maturation, with platelet concentrates like platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) showing promising results; PRP was associated with greater root length, while PRF showed superior apical healing. Variability in RET outcomes was noted due to the lack of standardized protocols. Comparative studies of RET versus apexification showed no significant differences in survival or overall success rates. RET often provides better apical closure and root development, though results vary. Both approaches are viable, but more research with standardized protocols and larger samples is needed to establish definitive clinical advantages. Conclusions: MTA apexification and RET are viable alternatives to CH apexification, with RET showing greater potential for root development and apical healing. Future research should focus on developing standardized protocols and uniform RET guidelines, and evaluating long-term outcomes to establish efficacy and safety. [ABSTRACT FROM AUTHOR]

Background: Pulpotomy is a crucial method to preserve primary teeth until natural exfoliation. This study aimed to evaluate the clinical and radiographic outcomes of pulpotomy with iRoot BP Plus in primary molars and to explore the association between hemostasis time and these outcomes. Methods: Primary molars that underwent iRoot BP Plus pulpotomy and were followed for at least 12 months were selected for this study. Clinical and radiographic data were collected, and the success rate was analyzed in relation to factors such as hemostasis time, tooth type, and arch type. The tests of significance used were the chi-square test, Fisher's exact test, or Kruskal-Wallis test. Statistical significance was set at P < 0.05. Results: A total of 183 teeth in 106 patients were included in the analysis. The follow-up period fell into a range of 1–3 years, with a mean of 1.6 years. The clinical and radiographic success rates were 96.7% and 92.9%, respectively. The earliest time to observe the radiographic failures was half a year after the treatment, and the latest time was two years after the treatment. Among all the teeth, 130 were recorded with hemostasis time before the application of iRoot BP Plus. Compared to teeth with a hemostasis time of 5 min or less, teeth with a hemostasis time exceeding 5 min showed no significant differences in clinical and radiographic success (P = 1.000 and 0.879). Additionally, neither arch nor teeth type showed a relationship with the pulpotomy success rate (P > 0.05). Conclusions: Pulpotomy using iRoot BP Plus in primary molars achieved favorable results. The hemostasis time may not significantly impact the outcomes of pulpotomy using iRoot BP Plus in primary molars. [ABSTRACT FROM AUTHOR]

This review aims to comprehensively explore calcium-enriched mixture (CEM) cement as a crucial biomaterial in dentistry/endodontics. With its growing clinical relevance, there is a need to evaluate its composition, chemical/physical/biological properties, clinical applications, and future perspectives to provide clinicians/researchers with a detailed understanding of its potential in endodontic procedures. Through systematic analysis of available evidence, we assess the advantages/limitations of CEM cement, offering valuable insights for informed decision-making in dental/endodontic practice. Our findings highlight the commendable chemical/physical properties of CEM cement, including handling characteristics, alkalinity, color stability, bioactivity, biocompatibility, sealing ability, and antimicrobial properties. Importantly, CEM cement has shown the potential in promoting regenerative processes, such as dentinogenesis and cementogenesis. It has demonstrated successful outcomes in various clinical applications, including vital pulp therapy techniques, endodontic surgery, open apices management, root resorption/perforation repair, and as an orifice/root canal obturation material. The efficacy and reliability of CEM cement in diverse clinical scenarios underscore its effectiveness in endodontic practice. However, we emphasize the need for well-designed clinical trials with long-term follow-up to further substantiate the full potential of CEM cement. This review serves as a robust reference for researchers/practitioners, offering an in-depth exploration of CEM cement and its multifaceted roles in contemporary dentistry/endodontics. [ABSTRACT FROM AUTHOR]

Background: Different materials have been used as wound dressings after vital pulp therapies. Some of them have limitations such as delayed setting, difficult administration, slight degree of cytotoxicity, crown discoloration and high cost. Therefore, to overcome these disadvantages, composite scaffolds have been used in regenerative dentistry. This study aims to construct and characterize the physicochemical behavior of a novel injectable alginate hydrogel loaded with different bioactive glass nanoparticles in various concentrations as a regenerative pulpotomy filling material. Methods: Alginate hydrogels were prepared by dissolving alginate powder in alcoholic distilled water containing mesoporous bioactive glass nanoparticles (MBG NPs) or boron-doped MBG NPs (BMBG NPs) at 10 and 20 wt% concentrations. The mixture was stirred and incubated overnight in a water bath at 50 0 C to ensure complete solubility. A sterile dual-syringe system was used to mix the alginate solution with 20 wt% calcium chloride solution, forming the hydrogel upon extrusion. Then, constructed hydrogel specimens from all groups were characterized by FTIR, SEM, water uptake percentage (WA%), bioactivity and ion release, and cytotoxicity. Statistical analysis was done using One-Way ANOVA test for comparisons between groups, followed by multiple pairwise comparisons using Bonferroni adjusted significance level (p < 0.05). Results: Alginate/BMBG loaded groups exhibited remarkable increase in porosity and pore size diameter [IIB1 (168), IIB2 (183) (µm)]. Similarly, WA% increased (~ 800%) which was statistically significant (p < 0.05). Alginate/BMBG loaded groups exhibited the strongest bioactive capability displaying prominent clusters of hydroxyapatite precipitates on hydrogel surfaces. Ca/P ratio of precipitates in IIA2 and IIB1 (1.6) were like Ca/P ratio for stoichiometric pure hydroxyapatite (1.67). MTT assay data revealed that the cell viability % of human gingival fibroblast cells have declined with increasing the concentration of both powders and hydrogel extracts in all groups after 24 and 48 h but still higher than the accepted cell viability % of (˃70%). Conclusions: The outstanding laboratory performance of the injectable alginate/BMBGNPs (20 wt%) composite hydrogel suggested it as promising candidate for pulpotomy filling material potentially enhancing dentin regeneration in clinical applications. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare postoperative pain following total pulpotomy (TP) and root canal treatment (RCT) in mature molar teeth with irreversible pulpitis. To compare the traditional pulpitis classification system with the Wolters system in evaluating postoperative pain. Methods: Eighty mandibular molars with irreversible pulpitis were included and classified according to the Wolters (moderate/severe pulpitis). The teeth were randomly assigned to two groups (RCT or TP). RCT was performed following standardized protocols. TP was performed to the level of the canal orifices, and hemostasis was achieved with 2.5% sodium hypochlorite. A 3 mm layer of MTA was placed as the pulpotomy material. The teeth were restored with glass ionomer cement followed by composite. Pain scores were recorded preoperatively and, at 6, 12, 24, 48, and 72 h and 7 days after the interventions. The data were statistically analyzed using the Mann-Whitney U test, the Friedman test, the Wilcoxon signed-rank test, and the Spearman’s correlation test. The significance level was set at 0.05. Results: Sixty-four patients were analyzed at the one-week follow-up and all were diagnosed as irreversible pulpitis according to the AAE; 22 teeth were classified as moderate and 42 teeth were classified as severe pulpitis according to Wolters. There was no significant difference between TP and RCT in pain scores in moderate pulpitis patients (p > 0.05). There was a significant difference between TP and RCT at 24 and 72 h of severe pulpitis; higher pain scores were observed in the RCT (p < 0.05). Conclusions: In patients with moderate pulpitis, the TP procedure allowed symptom relief more quickly than RCT. In patients with severe pulpitis, TP provided for significantly lower pain scores compared to RCT at both 24 and 72 h. Clinical trial registration: The study was retrospectively registered with ClinicalTrials.gov (NCT05923619). Date of Registration: 06/16/23. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare the tissue dissolving capacities of sodium and calcium hypochlorite [NaOCl and Ca(OCl)2] solutions applied without activation or with two irrigant activation methods. Materials and Methods: One hundred and eight dentin cavities were prepared. Preweighed tissue pieces were placed in these dentin cavities, and samples were divided into nine groups of twelve. In groups 1, 2, and 3, NaOCl was used with non-activation (NA), passive ultrasonic (PUA), and laser activation (LA). With the same techniques, Ca(OCl)2 was used in groups 4, 5, and 6, and distilled water was used in groups 7, 8, and 9. The weight loss of tissue samples was calculated and analyzed using Two-way ANOVA and Duncan tests. Results: Distilled water groups showed no tissue dissolution in any conditions. NaOCI and Ca(OCI)2 showed statistically similar dissolving effectiveness when used with the same technique. Activated groups dissolved significantly greater tissue than non-activated ones, the highest in LA. Conclusions: Ca(OCI)2 can be an alternative to NaOCl; for both, the first choice of activation may be the LA. [ABSTRACT FROM AUTHOR]

The decision making process for managing irreversible pulpitis in permanent teeth often involves choosing between pulpotomy and root canal treatment, with clinicians exercising discretion. This systematic review and meta-analysis aim to evaluate the efficacy of calcium silicate based pulpotomy in treating symptomatic permanent teeth with irreversible pulpitis. A comprehensive search across PubMed, Google Scholar, and SCOPUS databases yielded 482 articles. From this pool, 169 articles underwent further scrutiny. Following data filtration, presentation, and analysis, a meta-analysis was conducted using RevMan 5 software. Eleven articles were ultimately selected based on predefined inclusion and exclusion criteria. This meta-analysis revealed that calcium silicate based pulpotomy, employed in treating irreversible pulpitis cases, exhibited notable success rates ranging from 75% to 90% over a period of 15 years across most of the included studies. The majority of studies integrated into this systematic review reported successful outcomes for teeth with symptomatic irreversible pulpitis undergoing pulpotomy with the utilization of calcium silicate. Nonetheless, further research is necessary to delineate the precise roles of calcium silicate based pulpotomy in managing this condition. [ABSTRACT FROM AUTHOR]

Pulpotomy is recognized as a promising treatment option, especially for immature permanent teeth, as it prevents the unnecessary removal of radicular pulp tissue. The aim of the study was to evaluate the clinical and radiographic outcome of full pulpotomy using Biodentine in the young permanent tooth with symptomatic irreversible pulpitis. Full pulpotomy with Biodentine was performed on a 15-year-old male patient diagnosed with irreversible pulpitis in tooth #47. Follow-up was done at 6 months, 1 year, and 2 years postoperatively. The patient was asymptomatic throughout the follow-ups. 12-month postoperative radiograph revealed periapical healing and apical closure. 24-month radiographic follow-up revealed complete healing of the periapical lesion, but discrete pulp canal calcifications were also seen. Pulpotomy can be used successfully in the management of carious pulp exposure of fully erupted immature teeth to maintain pulp vitality and root maturation. [ABSTRACT FROM AUTHOR]

Aim: With modern dentistry advancements, children and parents have significantly raised aesthetic expectations in pediatric dentistry. Pediatric zirconia crowns (PZCs) provide a superior aesthetic appearance compared with stainless steel crowns (SSCs), making them a popular treatment option. However, a comparison of the compressive stresses caused by these crowns on the roots of primary teeth and alveolar bones has not been conducted. Materials and Methods: Cone beam computed tomography (CBCT) images of an eight-year-old female patient who experienced premature loss of a primary mandibular left second molar were obtained from a dental hospital database. Rhinoceros 4.0 software was used to process and simulate images. Under simulated chewing forces, stress on the PZC, SSC, and intact primary first molars as control groups, as well as their roots and alveolar bone structures, was assessed with finite element analysis. Statistical Analyses: Depending on whether the descriptive data were normally distributed, the Student t-test and Mann–Whitney U test were used. Quantitative variables differ between the two categories of qualitative variables. One-way ANOVA and Kruskal–Wallis H tests were used depending on standard distribution assumptions. p < 0.05 indicates statistical significance differences. Results: PZCs, SSCs, and cement layers were stressed according to von Mises values, while roots and alveolar bones were stressed according to maximum and minimum stress values. When assessing crowns, SSCs exhibited the highest von Mises stress values, followed by PZCs and control groups (p < 0.001). In the cement layer, SSCs obtained significantly higher values (p = 0.003). In the root area, minimum principal stress values are more critical. The highest values were obtained from the intact tooth, PZC, and SSC, respectively (p < 0.001). Alveolar bones did not differ significantly in minimum principal stress (p = 0.950). Conclusions: Restorative full-coverage crowns exhibited higher von Mises values than intact teeth, as per current research findings. The von Mises values were highest in SSC, while lowest in PZC. As a result of this condition, the cement layer and root areas had higher von Mises stress and compressive stress. Alveolar bones were not affected regardless of restoration type. PZC transmits higher stress due to its properties. [ABSTRACT FROM AUTHOR]

Background: Matrix metalloproteinases (MMPs) are critical enzymes involved in the remodeling and defense mechanisms of dental pulp tissue. While their role in permanent teeth has been extensively studied, research focusing on MMPs in primary teeth remains limited. This gap highlights the need for further investigations to understand the specific contributions of MMPs to pulpal defense in primary teeth. Moreover, the clinical efficacy of Biodentine as a pulpotomy material in primary teeth warrants further exploration through well-designed studies to establish its success and long-term outcomes in pediatric dentistry. Aim: This study aims to compare the expression levels of MMP-2, MMP-8, and MMP-9 in cases of reversible and irreversible pulpitis. Additionally, it seeks to evaluate the clinical success of Mineral Trioxide Aggregate (MTA) and Biodentine when used as pulpotomy agents in primary molars. By analyzing the differential expression of these MMPs, the study will contribute to a better understanding of their role in pulpal inflammation and the potential therapeutic outcomes of MTA and Biodentine in primary molars. Design: In this parallel randomized controlled trial, 63 mandibular primary second molars were assigned to two main groups: Group 1, consisting of 42 teeth diagnosed with reversible pulpitis, and Group 2, consisting of 21 teeth diagnosed with irreversible pulpitis. Group 1 was further divided into two randomized subgroups, each containing 21 teeth. The expression levels of MMP-2, MMP-8, and MMP-9 were evaluated in all samples. Pulpotomy treatments were performed using MTA and Biodentine in Group 1. Clinical and radiographic evaluations were conducted over an 18-month follow-up period. Statistical analyses were carried out using The Kolmogorov-Smirnov test, t-test and Fisher's exact test (p < 0.05). Results: The study revealed that MMP-2 and MMP-9 expression levels were significantly elevated in specimens with irreversible pulpitis (p = 0.01), indicating a potential correlation between these matrix metalloproteinases and the severity of pulpal inflammation. However, no significant difference was observed in the clinical success rates of pulpotomies performed with MTA and Biodentine, suggesting that both materials are equally effective in the treatment of primary molars with reversible pulpitis. Conclusions: The expression of MMP-2 and MMP-9 in pulpal blood presents a promising biomarker for assessing the degree of pulpal inflammation in primary teeth, offering a potentially valuable diagnostic tool. Additionally, the clinical success of Biodentine in pulpotomy procedures supports its viability as an effective alternative to MTA, providing a reliable option. Clinical Trial Registration ID: The study protocol has been registered with an ID: NCT05145686. Registration Date: 9th November 2021. [ABSTRACT FROM AUTHOR]

Background: Vital pulp therapy maintained functionality, vitality, and asymptomatic teeth. Compared to normal root canal treatment, pulpotomy was more helpful for irreversible pulpitis in adult permanent teeth. The research was aimed to assess effectiveness of vital pulp therapy using mineral trioxide aggregate with Apple Vinegar and Ethylene diamine tetra acetic acid (17%) for five minutes in adult carious exposed pulp of permanent teeth. Methods: Forty patients between 18 and 50 years old with a clinical diagnosis of symptomatic irreversible pulpitis but no periapical radiolucency were then divided randomly into two groups based on the irrigation method; ethylene diamine tetraacetic acid or apple vinegar. If pulpal bleeding could not be managed in less than six minutes, the assigned procedure was abandoned. After mineral trioxide aggregate application as a pulpotomy agent, glass ionomer and composite restoration were placed. Using a visual analogue scale, the pre and post-operative pain were recorded after 2,6,24,48, and 72 h. Success was assessed using radiographic and clinical examination data at three, six, and twelve months. Results: The success rate was discovered to be non-statistically significant in both groups after a year follow-up. Apple vinegar had a lower mean value than ethylene diamine tetra acetic acid at the preoperative baseline pain level, which was significant.Postoperatively, the ethylene diamine tetraacetic acid group reported the greatest mean value after two hours while Apple vinegar group reported the lowest mean values after 48 h (P < 0.05). After 72 h, pain level recorded insignificant difference. Conclusion: Apple vinegar yielded a marginally successful outcome but substantially improved pain alleviation. Trial registration: The trial was registered in Clinical trials.gov with this identifier NCT05970536 on 23/7/2023. [ABSTRACT FROM AUTHOR]

Various dressing materials have been evaluated for pulpotomy of primary teeth. However, an ideal pulp dressing material has not been identified yet. This systematic review investigated the effectiveness of TheraCal compared to Formocresol in pulpotomy of primary teeth. This research was conducted in the form of a secondary study, with a systematic search of texts until 2023 in Scopus, Web of Science, PubMed and Google Scholar databases. The articles were selected based on the inclusion and exclusion criteria and, finally the search results were reported in the PRISMA chart. The quality of the studies was evaluated based on the NIH checklist. The extracted information was entered into Stata17 software. Heterogeneity was evaluated using Cochran's chi-square test and I2 statistics. Egger's tests were used to detect publication bias. After removing duplicate articles and articles that did not meet the inclusion criteria, 4 studies were selected for qualitative analysis. The odds' ratio of success rate between Formocresol and TheraCal pulpotomy for absence of the pain, abscess, Mobility, internal root resorption and bone radiolucency was obtained 1.12 (95 % CI: 0.32, 3.85, P = 0.86), 0.47 (95 % CI: 0.1, 2.14, P = 0.33), 0.82 (95 % CI: 0.21, 3.21, P = 0.78), 0.89 (95 % CI: 0.3, 2.67, P = 0.84), and 1.96 (95 % CI: 0.68, 5.62, P = 0.21) respectively. The study results revealed that there was no significant difference in clinical and radiographic success between pulpotomy with TheraCal and Formocresol. [ABSTRACT FROM AUTHOR]

This study aims to investigate the effect of Mineral Trioxide Aggregate (MTA), a bioactive endodontic cement, and Concentrated Growth Factor (CGF), a second-generation autologous growth factor, on pulpotomy-induced pulp inflammation. The study utilized the maxillary anterior central teeth of thirty-six young male Sprague Dawley rats. Forty-eight teeth were randomly assigned to two groups (12 rats/group; 24 teeth/group) based on the capping material (MTA or CGF). Subsequently, two subgroups (MTAG and CGFG) were formed per group (12 teeth/group) based on the time following pulpotomy (2-weeks and 4-weeks). The central teeth of the 12 animals assigned to the control group (CG) were not manipulated in any way, both in the 2-week group and in the 4-week group. Tissue samples extracted from rats at the end of the experiment were stained with H&E for histopathological analysis. For immunohistochemical analysis, primary antibodies for TNF-α and NF-kβ/65 were incubated. Data obtained from semi-quantitative analysis were assessed for normal distribution using Skewness-Kurtosis values, Q-Q plot, Levene's test, and the Shapiro-Wilk test on statistical software. A P value < 0.05 was considered significant. When compared with the control group, both MTAG and CGFG showed increased edematous and inflammatory areas. In MTAG, edematous and inflammatory areas decreased significantly from the 2nd week (2(2–2), 2(1–2)) to the 4th week (1(1–1), 1(0–1)), while in CGFG, edematous areas decreased (2(2–3), 1.5(1–2)), and inflammatory areas increased significantly (2(2–3), 3(2-2.5)). When compared with the control group, TNF-α and NF-kβ/p65 positivity were higher in both MTAG and CGFG. In MTAG, TNF-α [2(1.5-2)] and NF-kβ/p65 [1.5(1–2)] positivity decreased significantly from the 2nd week to the 4th week [TNF-α: 1(1–1), NF-kβ/p65: 1(1–2)], while no significant change was observed in CGFG. In conclusion, this study revealed a reduction in cells showing TNF-α and NF-kβ/p65 positivity in the MTA treatment group compared to the CGF group. Although MTA demonstrated more favorable results than CGF in mitigating pulpal inflammation within the scope of this study, further experimental and clinical investigations are warranted to obtain comprehensive data regarding CGF. [ABSTRACT FROM AUTHOR]

Background: New and innovative materials are being marketed for the treatment of coronal pulpotomy. It is crucial to compare their efficacy with already-established materials. TheraCal PT (TP) is such a new material that studies are scarce. Aim: This study aim to compare and evaluate the outcome of coronal pulpotomy using Biodentine and a newly introduced calcium silicate-based dual-cure resin cement, TP, in patients with symptoms of irreversible pulpitis. Materials and Methods: Sixty patients with exposed carious pulp and symptomatic irreversible pulpitis were included, aged 18-40, randomly allocated to two groups: TP (group I) and Biodentine (group II). Coronal pulpotomy was performed following a standardized protocol, with TP or Biodentine applied accordingly. The pain was recorded using Visual Analog Scale preoperatively for up to 1 week. Success was assessed clinically and radiographically for up to 12 months. Statistical Analysis Used: The data were analyzed using the Friedman test and the Mann-Whitney U-test. Intragroup pain was analyzed using the Wilcoxon signed-rank test. Results: Among 60 patients, intervention was done in 53. By removing dropout patients, 47 were analyzed, with 38 available for follow-up at 3, 6, and 12 months. The Biodentine group exhibited a 12-month success rate of 84%, while the TP group revealed 77.3%, with statistically insignificant difference (P = 0.563). Conclusion: TP can be effectively utilized as a pulpotomy material in cases of symptomatic irreversible pulpitis in mature permanent teeth, offering rapid setting and ease of use, although Biodentine yielded slightly better results in this study. [ABSTRACT FROM AUTHOR]

Objective: Childhood experiences of pain associated with dental treatment can induce dental anxiety. Inferior alveolar nerve blocks are eight times more likely to fail in patients with irreversible pulpitis. The objective was to compare the effectiveness of lignocaine with and without pre-operative oral ibuprofen for controlling pain in primary mandibular molars scheduled for pulpectomy procedures in 5 to 9-year-old children. Methods: One hundred and twenty-two children diagnosed with irreversible pulpitis in mandibular posterior teeth and scheduled for pulpectomy procedures were included. The children were assigned to one of the two groups, Treatment group A: Pre-operative with oral ibuprofen and local anaesthesia with 2% lignocaine (with adrenaline 1:80000); Treatment group B: Pre-operative with oral placebo and local anaesthesia with 2% lignocaine (with 1:80000 adrenaline). Pain and pulse rate were recorded at baseline, one hour after administration of oral medication, fifteen minutes following administration of Inferior Alveolar Nerve Block (IANB), and also during the course pulpectomy. The results were statistically analysed using chi square test and repeated measures analysis of variance (ANOVA). Results: In treatment group A, 90.16% children had IANB success compared to 9.83% in group B.. The difference in the success rate between two groups was statistically significant (p<0.001) with an odds ratio of 84. Conclusion: Oral medication with ibuprofen is effective in increasing the success rate of IANB with lignocaine for the treatment of irreversible pulpitis of 5 to 9-year-old children. [ABSTRACT FROM AUTHOR]

Background: Pulpotomy is a common dental procedure used to treat extensively decayed primary teeth, aiming to preserve the vitality and function of the remaining pulp tissue. Various pulpotomy techniques and materials have been developed, but their long-term outcomes in terms of success rates and complications remain a subject of ongoing research. Materials and Methods: A total of 180 primary molars from children aged 4–8 years were treated using three different pulpotomy techniques: Formocresol (n = 60), Mineral Trioxide Aggregate (MTA) (n = 60), and Laser Pulpotomy (n = 60). Follow-ups were conducted at 6, 12, and 24 months posttreatment to evaluate clinical and radiographic success. Clinical success was defined by the absence of pain, swelling, and mobility, while radiographic success was indicated by the lack of internal resorption, furcation radiolucency, and periapical pathology. Results: At the 24-month follow-up, the clinical success rates were 80% for Formocresol, 95% for MTA, and 90% for Laser Pulpotomy. Radiographic success rates were 75% for Formocresol, 92% for MTA, and 88% for Laser Pulpotomy. MTA demonstrated the highest overall success rates, with statistically significant differences compared to Formocresol (P < 0.01) but not Laser Pulpotomy (P > 0.05). Conclusion: Mineral Trioxide Aggregate (MTA) showed superior long-term outcomes compared to Formocresol and comparable results to Laser Pulpotomy for the treatment of primary teeth.

Abstract This study aimed to evaluate the pulp response to F18 and cobalt-doped F18 bioglass (F18Co) in comparison with calcium hydroxide (CH) after pulp capping. The maxillary first molars of 48 rats were divided into F18, F18Co, CH, and control (no intervention) groups. The pulp was exposed, the materials were placed, and the teeth were capped. After 7 and 15 days, the animals were euthanized for pulp evaluation and interleukin (IL) expression determination. Statistical analysis was carried out using the SigmaPlot® program (Systat Software Inc., for Windows, version 12.0). The data obtained in the analyses were subjected to the non-parametric Kruskal-Wallis test, followed by Dunn's test. For all tests, statistical significance was set at p < 0.05. The CH group exhibited mild to moderate inflammation, whereas the bioglass groups displayed moderate to severe inflammation, indicating a notable difference between the control and bioglass groups. At 7 days, both the CH and most of the bioglass specimens showed moderate disorganization. On day 15, CH displayed mildto-moderate disorganization, whereas F18 and F18Co exhibited significantly more moderate-to-severe disorganization. There were no significant differences in IL-6 and IL-10 expressions between groups at 7 days, but a noteworthy increase in IL-1β was observed in both CH and F18. After 15 days, there was a greater expression of IL-6 and IL-1β in the bioglass groups. No significant IL-10 expression was observed. Bioglass performed less effectively than CH when in direct contact with the pulp tissue.

Traditionally, teeth with horizontal root fractures resulting in pulp infections have been managed with conventional root canal therapy; however, this technique is associated with a limited success rate. This study presents an unusual case of multiple horizontal root fractures of the maxillary central incisor caused by a traumatic injury. The preservation of vital dental pulp is advantageous for healing root fractures. Therefore, we performed a pulpotomy to maintain vitality of the root pulp. The tooth exhibited no clinical symptoms and regained its normal color. In cases of traumatic root fractures, prompt treatment is important once pulpitis is confirmed. Pulpotomy is highly recommended as this procedure preserves the remaining vital root pulp, thereby enhancing the potential for improved healing. The purpose of this study was to emphasize the difficulty associated with diagnosing multiple root fractures and the value of preserving the biological tissue.

Background Pulpotomy is a widely recommended treatment for deep caries and reversible pulpitis in primary teeth. However, there is a significant lack of large-scale clinical studies evaluating the long-term efficacy of pulpotomy in primary molars, especially in studies with follow-up periods extending beyond a two years. Aim This study aimed to evaluate the long-term efficacy of mineral trioxide aggregate (MTA) and iRoot BP Plus for pulpotomy in primary molars performed under general anesthesia and to investigate factors influencing the success rate. Methods In this retrospective study, a total of 942 primary molars from 422 children who met the inclusion criteria underwent pulpotomy. Propensity score matching method (PSM) was used to match the MTA and iRoot BP Plus groups in a 1:1 ratio based on covariates. Efficacy was assessed using the Zurn & Seale criteria. Kaplan-Meier survival analysis and Cox proportional hazards model were performed to analyze the outcomes. Results PSM resulted in 266 pairs of matched teeth from 532 teeth of 291 children (mean age: 4.64 ± 1.07 years, ranging from 2 to 8 years). Long-term clinical and radiographic evaluations revealed higher success rates for iRoot BP Plus (24-month: 99.54%/97.25%; 36-month: 97.22%/95.83%) compared to MTA (24-month: 94.76%/95.29%; 36-month: 92.50%/91.25%). Survival analysis indicated a statistically significant difference between two groups (P = 0.0042). Age, gender, tooth position, and decayed tooth surface showed no significant impact on pulpotomy success, whereas the choice of pulp capping materials significantly influenced the outcome (HR [95% CI]=0.3745[0.1857-0.7552], P = 0.006). Conclusion Clinical and radiographic evaluations support the use of iRoot BP Plus for pulpotomy in primary molars.

ABSTRACT: Background: Pulpotomy is a common dental procedure used to treat extensively decayed primary teeth, aiming to preserve the vitality and function of the remaining pulp tissue. Various pulpotomy techniques and materials have been developed, but their long-term outcomes in terms of success rates and complications remain a subject of ongoing research. Materials and Methods: A total of 180 primary molars from children aged 4–8 years were treated using three different pulpotomy techniques: Formocresol (n = 60), Mineral Trioxide Aggregate (MTA) (n = 60), and Laser Pulpotomy (n = 60). Follow-ups were conducted at 6, 12, and 24 months posttreatment to evaluate clinical and radiographic success. Clinical success was defined by the absence of pain, swelling, and mobility, while radiographic success was indicated by the lack of internal resorption, furcation radiolucency, and periapical pathology. Results: At the 24-month follow-up, the clinical success rates were 80% for Formocresol, 95% for MTA, and 90% for Laser Pulpotomy. Radiographic success rates were 75% for Formocresol, 92% for MTA, and 88% for Laser Pulpotomy. MTA demonstrated the highest overall success rates, with statistically significant differences compared to Formocresol (P < 0.01) but not Laser Pulpotomy (P > 0.05). Conclusion: Mineral Trioxide Aggregate (MTA) showed superior long-term outcomes compared to Formocresol and comparable results to Laser Pulpotomy for the treatment of primary teeth. [ABSTRACT FROM AUTHOR]

Endodontics is evolving with modern innovations for conservatively managing the various dental problems involving pulpal or periradicular tissue of primary and permanent teeth. Lasers have been reported with favorable clinical evidence, particularly in tackling the endodontic problems effectively. Recently, the application of lasers in the form of photobiomodulation therapy or low-level laser therapy has been reported in many recent scientific studies/researches with successful results. Hence, this narrative review critically appraise the existing scientific literature and highlights the photobiomodulation technique of lasers as noninvasive therapeutic modality in different pediatric endodontic therapies or procedures (direct pulp capping, pulpotomy, noninvasive treatment of periapical lesion, regenerative endodontics, postendodontic pain management, etc.).

Abstract Background The aim of this retrospective study was to determine the long-term clinical and radiographic success of our previous randomized clinical trial and to compare the success of hyaluronic acid, with the widely used formocresol and ferric sulphate agents. Methods This retrospective study is the extension of the 1-year survey of our randomized clinical trial that had compared the effectiveness of a hyaluronic acid pulpotomy over formocresol and ferric sulphate pulpotomies and included clinical and radiographic evaluations with a follow-up period of over 24 months for 44 children who applied to our clinic between May 2019 and September 2019. Long-term clinical and radiographic data were obtained from the periodic files of our department, wherein each tooth’s file was examined to identify any clinical and radiographic findings. Descriptive statistics and Pearson’s chi-square tests were used to evaluate the data. Statistical significance was considered as p 24 months. None of the teeth in the hyaluronic acid group showed any clinical findings at > 24 months. Conclusions Hyaluronic acid pulpotomies exhibited comparable success rates to formocresol and ferric sulphate materials spanning over 24 months examinations. Because of convenient accessibility and applicability of hyaluronic acid, it may be recommended as a promising alternative medicament for pulpotomy treatments of primary molars. However, further long-term follow-up human studies are needed to better understand the effect of hyaluronic acid on the dental pulp of human primary molars.