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ABSTRACT Objective: To compare the clinical and radiographic success rates of formocresol, BiodentineTM, and Endo Repair agents in primary molars after 12 months. Material and Methods: This randomized double-blind clinical trial was conducted on healthy children referred to the Department of Pediatric Dentistry, Kerman, Iran, in 2018. One hundred twenty children (human primary molar teeth) aged 3-9 years were selected and randomly divided into three interventions (with pulpotomy medicament agents), including formocresol, BiodentineTM, and Endo Repair. All pulpotomized teeth were restored using stainless steel crowns and evaluated clinically and radiographically during a 12-month follow-up. Fisher exact test was used to determine the association of categorical variables and the data were analysed with SPSS 25. Results: All the available teeth in formocresol and BiodentineTM groups obtained clinical success, whereas 62.5% of the Endo Repair group was successful in this regard. Radiographic success rates of the formocresol, BiodentineTM, and Endo Repair groups were 94.7%, 70%, and 28.1% after a 12-month follow-up, respectively. Moreover, pulp canal obliteration was observed in 26.3%, 25%, and 12.5% of the formocresol, BiodentineTM, and Endo Repair groups. Conclusion: This study reported a high rate of clinical success using both BiodentineTM and formocresol pulpotomy techniques. However, the radiographic success rate of formocresol was higher than that of BiodentineTM, and Endo Repair was not considered a suitable pulpotomy medicament agent.

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Objetivo: Analizar la eficacia clínica del Agregado Trióxido Mineral (MTA) en pulpotomías a través de estudios comparativos con el formocresol, sulfato férrico e hidróxido de calcio; en pacientes pediátricos con edad de tres a nueve años. Materiales y Métodos: El artículo se basa en una revisión sistemática de la literatura, por ello, se utilizaron como fuentes de información las bases de datos: PubMed, Scielo, y Biblioteca Virtual de Salud. Asimismo, como criterios de inclusión se establecieron publicaciones del año 2008 al 2019, cuya procedencia se derivó de journalsy revistas académicas arbitradas; los cuales permitieron obtener dieciséis ensayos que evaluaban la eficacia clínica a través de los signos y síntomas de las patologías pulpares más comunes: absceso, inflamación gingival, movilidad patológica, dolor a la percusión y dolor espontáneo. Resultados: El MTA obtuvo una eficacia de 97,9% en contraposición al 86,9% del Sulfato Férrico. En relación al Formocresol, el MTA logró el 99% contra un 98,3% de eficacia. Además, en la comparación del MTA con el Hidróxido de Calcio el primero logró un 98,2% y el segundo 74,5%. Conclusiones: El MTA obtuvo una mayor eficacia clínica debido a su biocompatibilidad, pH básico y su elevada facultad al sellar la cámara pulpar. Por lo tanto, puede emplearse como un material seguro para las pulpotomías de pacientes pediátricos.

Objetivo: Analisar a eficácia clínica do Agregado de Trióxido Mineral (MTA) em pulpotomias através de estudos comparativos com formocresol, sulfato férrico e hidróxido de cálcio; em pacientes pediátricos de três a nove anos de idade. Materiais e Métodos: O artigo é baseado em uma revisão sistemática da literatura, portanto, bases de dados foram utilizadas como fontes de informação: PubMed, Scielo, e Biblioteca Virtual. Da mesma forma, como critério de inclusão, foram estabelecidas publicações de 2008 a 2019, cuja origem foi derivada de periódicos e revistas acadêmicas de referência; o que nos permitiu obter dezesseis ensaios que avaliaram a eficácia clínica através dos sinais e sintomas das doenças mais comuns da polpa: abscesso, inflamação gengival, mobilidade patológica, dor na percussão e dor espontânea. Resultados: A MTA obteve uma eficácia de 97,9% contra 86,9% para o sulfato férrico. Em relação ao Formocresol, o MTA alcançou 99% contra 98,3% de eficácia. Além disso, na comparação do MTA com o hidróxido de cálcio, o primeiro atingiu 98,2% e o segundo 74,5%. Conclusões: A MTA obteve uma maior eficácia clínica devido a sua biocompatibilidade, pH básico e sua alta faculdade ao selar a câmara de celulose. Portanto, pode ser usado como material segura para pulpotomias de pacientes pediátricos.

Objective: To analyze the clinical efficacy of the Mineral Trioxide Aggregate (MTA) in pulpotomies through comparative studies with formocresol, ferric sulfate and calcium hydroxide; in pediatric patients aged three to nine years. Materials and Methods: The article is based on a systematic review of the literature, therefore, databases were used as sources of information: PubMed, Scielo, and Virtual Health Library. Likewise, as inclusion criteria, publications from 2008 to 2019 were established, whose origin was derived from journals and refereed academic journals; which allowed us to obtain sixteen trials that evaluated clinical efficacy through the signs and symptoms of the most common pulp diseases: abscess, gingival inflammation, pathological mobility, pain on percussion and spontaneous pain. Results: MTA obtained an efficacy of 97.9% as opposed to 86.9% for ferric sulfate. Concerning to Formocresol, MTA achieved 99% versus 98.3% efficacy. Also, in the comparison of MTA with Calcium Hydroxide, the former achieved 98.2% and the latter 74.5%. Conclusions: MTA obtained a higher clinical efficacy due to its biocompatibility, basic pH and its high faculty when sealing the pulp chamber. Therefore, it can be used as a safe material for pediatric patient pulpotomies.

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RESUMEN: Introducción: En dentición primaria, la pulpotomía con formocresol ha sido convencionalmente utilizada para el tratamiento de caries cercanas a la pulpa. Sin embargo, la seguridad de este material ha sido cuestionada. Por otro lado, el biodentine ha sido propuesto como un biomaterial sustituto bioactivo de la dentina, pero no está clara su efectividad. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y una tabla GRADE para el resumen de los resultados. Resultados y conclusiones: Identificamos tres revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos correspondientes a ensayos aleatorizados. Concluimos que no se puede establecer con claridad si biodentine comparado con formocresol aumenta el éxito clínico y el éxito radiográfico en pulpotomía en pacientes con dentición primaria, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: Pulpotomy with formocresol is the main treatment protocol following carious pulp exposure in primary teeth, but many concerns have been raised regarding its safety. Biodentine has been proposed as a bioactive dentine substitute, but there is still uncertainty regarding its effectiveness. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified three systematic reviews including two studies overall, of which both were randomized trials. We are uncertain whether biodentine compared to formocresol for pulpotomy improves clinical and radiographic success, as the certainty of the evidence has been assessed as very low.

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OBJECTIVES: This in vivo research investigated whether pulp treatments using formocresol for 7 days would cause mutagenic changes in children's lymphocytes. MATERIALS AND METHODS: The mutagenicity was tested in lymphocyte cultures established from the peripheral blood of children living in Brazil. The samples consisted of 2000 cells from teeth undergoing formocresol pulpotomies in which the formocresol pellet was sealed in the primary tooth for 7 days. It was removed on the seventh day, the base was placed, and the tooth was restored. Two venous blood samples (6-8 ml) were collected from each child; the first was prior to pulp therapy, and the second was 7 days later. Two thousand metaphases were analyzed. The level of significance adopted for the statistics was P < 0.05, and a random effects meta-analysis was performed combining this and two previous studies. RESULTS: There was no significant difference found in the metaphase analysis between the blood samples taken before and after the pulpotomy treatment (Wilcoxon signed rank test); however, the meta-analysis showed a significant difference between the combined studies. CONCLUSIONS: This study did not reveal any mutagenic effects, but based on the combined meta-analysis, we recommend the careful use of formocresol. CLINICAL RELEVANCE: This research helps to bring scientific evidence of the safe use of formocresol in deciduous pulpotomy treatments.

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Objective: To determine and compare the efficacy of Amniotic Membrane (AM) as a pulpotomy agent with Formocresol (FC) clinically and radiographically. Material and Methods: 30 deciduous molars warranted for pulpotomy in 24 children (4-9 years) were divided equally into two groups of 15 each. Group1: Amniotic membrane pulpotomy and Group 2: Formocresol pulpotomy, which was followed by placement of glass ionomer cement and stainless steel crown restoration. The patients were recalled after 1, 3, 6 and 9 months for clinical and radiographic evaluation. Fisher's exact test and Mcnemar test were used for statistical analysis. Results: Results indicated both clinically and radiographically amniotic membrane performed at par with formocresol. Conclusion: Amniotic membrane with its regenerative, antibacterial properties and the ability to deliver growth factors has shown promising results comparable to gold standard formocresol when used as a pulpotomy agent and hence can be recommended as an alternative pulpotomy agent.

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El objetivo de este trabajo fue evaluar clínica y radiográficamente la efectividad de la pasta antibiótica CTZ en pulpotomías de molares primarios. Se realizó un ensayo clínico aleatorio controlado, en 40 molares primarios de 40 preescolares con edades entre 3 y 6 años. Los pacientes fueron seleccionados y asignados aleatoriamente a dos grupos: Formocresol (n=20), CTZ (Cloranfenicol-Tetraciclina-Oxido de Zinc Eugenol, n=20). Los dientes fueron restaurados con ionómero de vidrio y coronas metálicas de acero preformadas. La evaluación clínica y radiográfica fue realizada a los 3 y 6 meses. Se utilizó el programa SPSS v.17 para el análisis de los datos, y la aplicación del Test Exacto de Fisher al 5 %. El comportamiento clínico a los 3 meses mostró 75 % de éxito para los molares tratados con formocresol y 70 % para el CTZ. Radiográficamente se obtuvo 90 % de éxito para el grupo con formocresol y 100 % para la pasta CTZ. A los 6 meses el éxito clínico del formocresol fue de 85 % y del CTZ 80 %. El éxito radiográfico mostrado fue 65 % para los atendidos con formocresol y 80 % para el CTZ (p > 0,05). No se observaron diferencias significativas entre los grupos de tratamiento. La pasta CTZ es una alternativa en el tratamiento de pulpotomías de molares temporales. Ofrece un efecto antimicrobiano, estabilización del proceso de reabsorción radicular, sin ocasionar daños a la formación del diente permanente.

The objective of this study to evaluate the clinical and radiographic effectiveness of antibiotic paste CTZ in pulpotomy of primary molars. A randomized controlled clinical trial was performed, in 40 molars of 40 patients aged 3 to 6 years. Were selected and randomly assigned to two groups: Formocresol (n=20), CTZ (Chloramphenicol-Tetracycline-Zinc Oxide Eugenol, n=20). The teeth were restored with glass ionomer and performed steel metal crowns. Clinical and radiographic evaluation procedure was performed at 3 and 6 months. SPSS v.17 program for data analysis, and application of the Fisher exact test was used 5 %. The clinical behavior at 3 months showed 75 % success rate for molars treated with formocresol and 70 % for the CTZ. Radiographically 90 % success rate for the group with formocresol and 100 % for the CTZ paste was obtained. At 6 months formocresol clinical success was 85 % and 80 % CTZ. Radiographic success was shown 65 % for those treated with formocresol and 80 % for the CTZ (p>0.05). No significant differences in the results shown were observed. CTZ paste is an alternative in the treatment of pulpotomy of molars. It provides an antimicrobial effect, stabilizing the process of root resorption, without causing damage to the permanent tooth formation.

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El mantenimiento de las piezas dentarias para desempeñar sus funciones en la alimentación, en la expresión oral, en el mantenimiento de espacios en las arcadas dentarias, en el estímulo para el crecimiento y desarrollo de los maxilares, entre otras acciones, ha sido considerado esencial para el logro de un desarrollo armónico. Por otro lado, y a pesar de los avances en la materia, la caries dental es la causa más frecuente de las patologías pulpares en los dientes primarios y constituye el principal motivo de su deterioro y/o su pérdida. Las características histo-patológicas de la pulpa dental, la brevedad de su ciclo vital, el tamaño relativo de las cámaras pulpares, favorecen el rápido compromiso pulpar y propician que el proceso infeccioso progrese rápidamente a la necrosis. Ello ha determinado y determina el desarrollo de numerosas técnicas y tratamientos, diferentes ofertas terapéuticas de las cuales ninguna ha alcanzado el consenso universal. Como establecen las Guías de Odontología Pediátrica sobre tratamientos pulpares en dientes primarios, la literatura dental en esta área ofrece escasa y pobre evidencia para sustentar las diferentes técnicas y constantemente señalan la necesidad de nuevos y rigurosos estudios que la avalen.

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AIM: The aim of this study was to evaluate the scientific evidence of pulpotomy in primary teeth comparing mineral troxide aggregate (MTA), calcium hydroxide, ferric sulphate, and electrosurgery with formocresol. METHODS: A systematic search using key words was conducted using seven databases up to December 10, 2013. Clinical articles in English, Portuguese and Spanish were selected, which were in accordance with the inclusion and exclusion criteria and the research objective of comparing whether pulpotomy performed with formocresol in primary teeth is more effective than other medicaments or techniques. RESULTS: Out of the 12,515 publication initially identified, 30 clinical articles were included in the systematic review and analysed by four meta-analyses. The success rate of MTA (94.6 %) was higher than that of formocresol (87.4 %), with a statistically significant difference (OR = 0.39; 95 % CI = 0.25-0.62). Formocresol pulpotomy success was not statistically different from ferric sulphate or electrosurgery. CONCLUSION: MTA was clinically and radiographically superior to formocresol for pulpotomy of primary teeth. The other alternatives to formocresol such as electrosurgery and ferric sulphate can be used instead of formocresol since they showed success similar to formocresol. In addition, there is no evidence to support calcium hydroxide for pulpotomies in primary teeth.

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AIM: This study aimed to compare the clinical and radiographic effectiveness of Low Level Laser Therapy in vital pulp of human primary teeth. METHODS: Sixty mandibular primary molars of children aged between 5-9 years were assigned into four groups: Diluted Formocresol (FC), Calcium Hydroxide (CH), Low Level Laser Therapy (LLLT) and Calcium Hydroxide preceded by Low Level Laser Therapy (LLLT + CH). The clinical and radiographic evaluations were performed at 6, 12 and 18 post-operative months. RESULTS: All the groups studied were successful in the clinical evaluation over the follow-up period. At 6 months, the radiographic success rate for FC group was 100%, 60% for CH group, 80% for LLLT group and 85.7% for LLLT + CH group. After 12 months, the radiographic success rate was 100% for FC group, 50% for CH group, 80% for LLLT group and 78.6% for LLLT + CH group. At the 18 months follow-up, 100% of the FC group, 66.7% of CH group, 73.3% of the LLLT group and 75% of the LLLT + CH group. CONCLUSION: These findings suggest that Low Level Laser Therapy may be considered as an adjuvant alternative for vital pulp therapy on human primary teeth. Low Level Laser Therapy preceding the use of calcium hydroxide showed satisfactory results.

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The aim of this study was to evaluate, clinically and histologically, the influence of laser and LED photobiomodulation in the healing of formocresol-induced oral mucosa ulcers of rats. We used 60 Wistar rats in which oral ulcers were induced on the gingiva of the lower incisors. Forty-eight hours after inducing the ulcers, the animals were divided into three groups: laser, LED, and untreated. Animals from the laser group received irradiation with GaAlAs, 660 nm, CW, 40 mW, φ 4 mm(2), 4.8 J/cm(2). Animals from the LED group received irradiation with InGaAIP, 630 nm, 150 mW, 4.8 J/cm(2), 0.8 cm spot. Forty-eight hours after oral ulcer induction, both irradiations were applied in a punctuate manner in the center of the ulcer at 48-h interval until the end of the experimental period. The animals were killed at 3, 5, 7, and 11 days after day 0. The results of the clinical evaluation showed that the laser and LED phototherapies were able to accelerate the healing of formocresol-induced oral ulcers, which occurred first in the laser group (ANOVA, p < 0.05). Histologically, there was a slight variation between LED and laser therapy; therefore, the laser group proved to be effective in accelerating wound healing, especially at 5 days, whereas the LED group was more effective at the end of the experimental period. It was concluded that laser and LED photobiomodulation were effective in accelerating the healing of formocresol-induced oral ulcers in both clinical and histological aspects.

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Objetivo: este estudo longitudinal retrospectivo objetivou avaliar se existe relação entre o surgimento de manchas de esmalte em pré-molares, após o tratamento endodôntico dos seus antecessores molares decíduos.Métodos: as crianças submetidas à pesquisa, pacientes do Instituto de Medicina Integral Professor Fernando Figueira (IMIP), desde a mais tenra idade, foram localizados, juntamente com seus prontuários, e agrupados igualmente em três grupos conforme avaliação: (1) pré-molares sucessores de dentes decíduos que foram submetidos ao tratamento endodôntico com sessão única de Formocresol; (2) pré-molares sucessores de dentes decíduos que foram submetidos ao tratamento endodôntico com CTZ; (3) pré-molares cujos molares decíduos antecessores não possuíam lesões de acometimento pulpar. Um único examinador, com o intuito de identificar manchas de esmalte, avaliou 180 pré-molares, sem conhecimento prévio do histórico clínico ao qual foram submetidos seus antecessores decíduos,utilizando inspeção visual conferindo um índice Cohen´s kappa = 0,90. O teste de Qui-quadrado de Person e o exato de Fisher foram utilizados para identificar as diferenças entre os grupos experimentais e entre os grupos experimentais e o controle, respectivamente, em relação ao surgimento de manchas. O nível de significância adotado nesse estudo foi de 5%. Resultados: foi identificado que 8,3% dos pré-molares tratados com Formocresol e 11,7% tratados com o CTZ apresentaram algum tipo de mancha no esmalte (p>0.05), no entanto, não foram detectadas manchas nos dentes do grupo controle (p<0.05). Conclusão: quando os dentes antecessores decíduos foram submetidos à terapia endodôntico com Formocresol ou CTZ, houve surgimento de manchas em pré-molares, não havendo, no entanto, diferença estatisticamente significante...

Objective: The aim of this longitudinal retrospective study was to investigate whether there is association of the presence of enamel stains in premolars after endodontic treatment of their primary molar predecessors. Method: The children of this research have been patients of the Integral Medicine Institute Professor Fernando Figueira (IMIP) since their earliest age. The children were localized, their clinical charts were retrieved, and three groups were formed according to the evaluation: (1) successor premolars of primary molars subjected to single-session endodontic treatment with formocresol; (2) successor premolars of primary molars subjected to endodontic treatment with CTZ paste; and (3) successor premolars of primary molars that had no previous pulp involvement. A single examiner blinded to the clinical history of the primary molar predecessors evaluated 180 premolars for enamel stains by visual inspection, with a Cohen?s index kappa=0.90. Pearson?s square chi and Fisher?s exact tests were used to identify the differences among the experimental groups, and between the control and experimental groups, respectively, as regards the presence of enamel stains. The significance level was set at 5%. Results: 8.3% of the premolars that had the primary molar predecessors treated with formocresol and 11.7% of those treated with CTZ had some kind of enamel stain (p>0.05). There were no enamel stains in the teeth of the control group (p less than 0.05). Conclusion: When the primary molar predecessors were subjected to endodontic treatment with both formocresol and CTZ, enamel stains developed in the premolars, though without statistically significant difference...

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O objetivo deste estudo foi avaliar: 1) a resposta pulpar de dentes decíduos humanos após pulpotomia com diferentes materiais capeadores por meio de análise clínica, radiográfica e histológica; e 2) a expressão da Proteína 1 da Matriz Dentinária (DMP-1) na resposta pulpar. Vinte e cinco molares decíduos inferiores de 22 crianças com idade entre 6 e 9 anos foram criteriosamente selecionados. Os dentes foram randomicamente divididos nos grupos Formocresol de Buckley diluído a 1/5 (Grupo I - FC), Hidróxido de Cálcio (Grupo II HC), Agregado Trióxido Mineral (Grupo III MTA), Otosporin® + Hidróxido de Cálcio (Grupo IV OTO+HC) e Cimento Portland (Grupo V PC), e tratados pela técnica convencional de pulpotomia em sessão única. As avaliações clínicas e radiográficas foram realizadas até o período normal de esfoliação. Os dentes foram extraídos e processados para análise histológica e imuno-histoquímica. Os resultados clínicos e radiográficos não mostraram diferença estatisticamente significativa nos grupos estudados (p>0,05). A análise estatística da avaliação histológica revelou diferença estatisticamente significativa para presença de barreira dentinária e camada odontoblástica entre o Grupo I(FC) e os Grupos II(HC), III(MTA), IV(OTO+HC) e V(PC) visto que o Grupo I(FC) não apresentou barreira dentinária e camada odontoblástica em nenhuma das lâminas observadas. Não houve diferença estatisticamente significativa entre os grupos estudados quando da avaliação da calcificação pulpar. Para o item reabsorção interna observou-se diferença estatisticamente significativa entre o Grupo I(FC), II(HC) e os Grupos III(MTA), IV(OTO+HC) e V(PC) onde não se observaram reabsorções internas nas análises histológicas. A análise da expressão da DMP-1 demonstrou para o Grupo I(FC) imunomarcação localizada na região de calcificações pulpares localizadas nas raízes dos dentes avaliados, não havendo camada odontoblástica nem formação de barreira dentinária. Os Grupos II(HC), III...

The aim of this study was to evaluate: 1) the pulpal response of human primary teeth after pulpotomies with different pulp capping materials through clinical, radiographic and histological analysis; and 2) the expression of Dentin Matrix Protein 1 (DMP-1) in the pulpal response. Twenty-five primary molars of 22 children aged 6-9 years-old were criteriously selected. The teeth were randomly divided into the following groups: Buckleys Formocresol (diluted 1:5) (Group I - FC), Calcium Hydroxide - (Group II CH), Mineral Trioxide Aggregate (Group III MTA), Otosporin® + Calcium Hydroxide (Group IV OTO+CH) and Portland cement (Group V PC); and treated by the conventional technique of pulpotomy at a single appointment. The clinical and radiographic evaluations were performed until the teeth underwent normal exfoliation. The teeth were extracted and processed for histological and immunohistochemical analyses. The clinical and radiographic studies did not show statistically significant difference among the groups studied (p>0.05). The statistical analysis of the histological evaluation revealed statistically significant difference relating to the presence of the dentine barrier and odontoblastic layer between Group I(FC) and Groups II(CH), III(MTA), IV(OTO+CH) and V(PC) since the Group I(FC) did not exhibited dentine barrier and odontoblastic layer in any of the cuts observed. There was no statistically significant difference among the groups studied regarding to the evaluation of pulpal calcification. Concerning to internal resorption, there was a statistically significant difference among Group I(FC), II(CH) and Groups III(MTA), IV(OTO+CH) and V(PC) where internal resorption was not seen in the histological analyses. The analysis of the expression DMP-1 demonstrated for Group I(FC) immunostaining located in the area of pulpal calcifications within the roots of the teeth evaluated; however, neither odontoblastic layer nor dentine barrier were seen...

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O objetivo deste estudo foi avaliar: 1) a resposta pulpar de dentes decíduos humanos após pulpotomia com diferentes materiais capeadores por meio de análise clínica, radiográfica e histológica; e 2) a expressão da Proteína 1 da Matriz Dentinária (DMP-1) na resposta pulpar. Vinte e cinco molares decíduos inferiores de 22 crianças com idade entre 6 e 9 anos foram criteriosamente selecionados. Os dentes foram randomicamente divididos nos grupos Formocresol de Buckley diluído a 1/5 (Grupo I - FC), Hidróxido de Cálcio (Grupo II HC), Agregado Trióxido Mineral (Grupo III MTA), Otosporin® + Hidróxido de Cálcio (Grupo IV OTO+HC) e Cimento Portland (Grupo V PC), e tratados pela técnica convencional de pulpotomia em sessão única. As avaliações clínicas e radiográficas foram realizadas até o período normal de esfoliação. Os dentes foram extraídos e processados para análise histológica e imuno-histoquímica. Os resultados clínicos e radiográficos não mostraram diferença estatisticamente significativa nos grupos estudados (p>0,05). A análise estatística da avaliação histológica revelou diferença estatisticamente significativa para presença de barreira dentinária e camada odontoblástica entre o Grupo I(FC) e os Grupos II(HC), III(MTA), IV(OTO+HC) e V(PC) visto que o Grupo I(FC) não apresentou barreira dentinária e camada odontoblástica em nenhuma das lâminas observadas. Não houve diferença estatisticamente significativa entre os grupos estudados quando da avaliação da calcificação pulpar. Para o item reabsorção interna observou-se diferença estatisticamente significativa entre o Grupo I(FC), II(HC) e os Grupos III(MTA), IV(OTO+HC) e V(PC) onde não se observaram reabsorções internas nas análises histológicas. A análise da expressão da DMP-1 demonstrou para o Grupo I(FC) imunomarcação localizada na região de calcificações pulpares localizadas nas raízes dos dentes avaliados, não havendo camada odontoblástica nem formação de barreira dentinária. Os Grupos II(HC), III...

The aim of this study was to evaluate: 1) the pulpal response of human primary teeth after pulpotomies with different pulp capping materials through clinical, radiographic and histological analysis; and 2) the expression of Dentin Matrix Protein 1 (DMP-1) in the pulpal response. Twenty-five primary molars of 22 children aged 6-9 years-old were criteriously selected. The teeth were randomly divided into the following groups: Buckleys Formocresol (diluted 1:5) (Group I - FC), Calcium Hydroxide - (Group II CH), Mineral Trioxide Aggregate (Group III MTA), Otosporin® + Calcium Hydroxide (Group IV OTO+CH) and Portland cement (Group V PC); and treated by the conventional technique of pulpotomy at a single appointment. The clinical and radiographic evaluations were performed until the teeth underwent normal exfoliation. The teeth were extracted and processed for histological and immunohistochemical analyses. The clinical and radiographic studies did not show statistically significant difference among the groups studied (p>0.05). The statistical analysis of the histological evaluation revealed statistically significant difference relating to the presence of the dentine barrier and odontoblastic layer between Group I(FC) and Groups II(CH), III(MTA), IV(OTO+CH) and V(PC) since the Group I(FC) did not exhibited dentine barrier and odontoblastic layer in any of the cuts observed. There was no statistically significant difference among the groups studied regarding to the evaluation of pulpal calcification. Concerning to internal resorption, there was a statistically significant difference among Group I(FC), II(CH) and Groups III(MTA), IV(OTO+CH) and V(PC) where internal resorption was not seen in the histological analyses. The analysis of the expression DMP-1 demonstrated for Group I(FC) immunostaining located in the area of pulpal calcifications within the roots of the teeth evaluated; however, neither odontoblastic layer nor dentine barrier were seen...

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O objetivo deste estudo foi verificar por meio de observações clínicas e radiográficas a resposta in vivo do complexo dentinopulpar de dentes decíduos humanos após pulpotomia com diferentes terapêuticas para manter a vitalidade pulpar. Sessenta molares decíduos inferiores de crianças com idade entre 5 e 9 anos foram criteriosamente selecionados. Os dentes foram randomizadamente divididos nos grupos Formocresol de Buckley diluído a 1/5 (Grupo I), Hidróxido de Cálcio (Grupo II), Laser de Baixa Intensidade (Grupo III) e Hidróxido de Cálcio precedido por Laser de Baixa Intensidade (Grupo IV) e tratados pela técnica convencional de pulpotomia em uma única sessão. As avaliações clínicas e radiográficas foram realizadas nos períodos de 3, 6 e 12 meses do pós-operatório. Nos resultados observou-se que clinicamente não houve diferença estatisticamente significativa nos grupos estudados. Radiograficamente houve associação em relação à presença de reabsorção interna no grupo II (HC) dos 3 meses para os 6 meses e dos 3 meses para os 12 meses de proservação (p= 0,04) e, em relação à presença de calcificação pulpar nos grupos I (FC) com p=0,04 e no grupo III (LBI+OZE) com p=0,01 dos 3 meses para os 12 meses e dos 6 meses para os 12 meses. Na comparação entre os grupos, a análise estatística dos resultados demonstrou que houve associação entre formação de barreira dentinária entre os grupos I (FC) e II (HC), entre os grupos I (FC) e IV (LBI+HC), entre os grupos II (HC) e III (LBI+OZE) e entre os grupos III (LBI+OZE) e IV (LBI+HC) nos três períodos de avaliação (p=0,00). O Formocresol apresentou os maiores índices de sucesso clínico e radiográfico entre os grupos de estudo, entretanto não está associado à formação de barreira dentinária. O Laser de Baixa Intensidade mostrou maiores índices de sucesso clínico e radiográfico com relação à reabsorção interna e calcificação pulpar em comparação com os grupos II (HC) e IV (LBI+HC), entretanto também não está associado...

The aim of this study was to determine through clinical and radiographic observations response in vivo dentinopulpar complex in human deciduous teeth after pulpotomy with different therapies to maintain their pulp vitality. Sixty mandibular primary molars of children aged between 5 and 9 years were carefully selected. The teeth were randomly divided into groups Formocresol Buckley diluted 1/5 (Group I), Calcium Hydroxide (Group II), Low Intensity Laser (Group III) and Calcium Hydroxide preceded by Low Intensity Laser (Group IV) and treated by a conventional pulpotomy technique in a single session. The clinical and radiographic evaluations were performed at 3, 6 and 12 months postoperatively. The results showed that there was no clinically significant difference among groups. Radiographically there was an association for the presence of internal reabsorption in the group I (FC) of 3 months to 6 months and 3 months to 12 months, and an association for the presence of pulp calcification in groups I (FC) with p=0,04 and group III (LBI+ZOE) with p=0,01 of 3 months to 12 months and 6 months to 12 months. In comparison among the groups in each period, the statistical analysis of results showed that there was an association between the formation of dentin barrier for groups I (FC) and II (CH), for groups I (FC) and IV (LBI+CH), for groups II (CH) and III (LBI+ZOE) and for groups III (LBI+ZOE) and IV (LBI+CH) in the three periods evaluation (p = 0.00). The formocresol showed the higher levels of clinical and radiografic success among the study groups, however is not associated with the formation of dentin barrier. The Low Intensity Laser showed higher levels of clinical and radiographic success with respect to internal resorption and pulp calcification compared with groups II (CH) and IV (LBI + CH), but it is also not associated with the formation of dentin barrier. Thus, it is suggested that Low Intensity Laser may be considered an alternative...

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O objetivo deste estudo foi verificar por meio de observações clínicas e radiográficas a resposta in vivo do complexo dentinopulpar de dentes decíduos humanos após pulpotomia com diferentes terapêuticas para manter a vitalidade pulpar. Sessenta molares decíduos inferiores de crianças com idade entre 5 e 9 anos foram criteriosamente selecionados. Os dentes foram randomizadamente divididos nos grupos Formocresol de Buckley diluído a 1/5 (Grupo I), Hidróxido de Cálcio (Grupo II), Laser de Baixa Intensidade (Grupo III) e Hidróxido de Cálcio precedido por Laser de Baixa Intensidade (Grupo IV) e tratados pela técnica convencional de pulpotomia em uma única sessão. As avaliações clínicas e radiográficas foram realizadas nos períodos de 3, 6 e 12 meses do pós-operatório. Nos resultados observou-se que clinicamente não houve diferença estatisticamente significativa nos grupos estudados. Radiograficamente houve associação em relação à presença de reabsorção interna no grupo II (HC) dos 3 meses para os 6 meses e dos 3 meses para os 12 meses de proservação (p= 0,04) e, em relação à presença de calcificação pulpar nos grupos I (FC) com p=0,04 e no grupo III (LBI+OZE) com p=0,01 dos 3 meses para os 12 meses e dos 6 meses para os 12 meses. Na comparação entre os grupos, a análise estatística dos resultados demonstrou que houve associação entre formação de barreira dentinária entre os grupos I (FC) e II (HC), entre os grupos I (FC) e IV (LBI+HC), entre os grupos II (HC) e III (LBI+OZE) e entre os grupos III (LBI+OZE) e IV (LBI+HC) nos três períodos de avaliação (p=0,00). O Formocresol apresentou os maiores índices de sucesso clínico e radiográfico entre os grupos de estudo, entretanto não está associado à formação de barreira dentinária. O Laser de Baixa Intensidade mostrou maiores índices de sucesso clínico e radiográfico com relação à reabsorção interna e calcificação pulpar em comparação com os grupos II (HC) e IV (LBI+HC), entretanto também não está associado...

The aim of this study was to determine through clinical and radiographic observations response in vivo dentinopulpar complex in human deciduous teeth after pulpotomy with different therapies to maintain their pulp vitality. Sixty mandibular primary molars of children aged between 5 and 9 years were carefully selected. The teeth were randomly divided into groups Formocresol Buckley diluted 1/5 (Group I), Calcium Hydroxide (Group II), Low Intensity Laser (Group III) and Calcium Hydroxide preceded by Low Intensity Laser (Group IV) and treated by a conventional pulpotomy technique in a single session. The clinical and radiographic evaluations were performed at 3, 6 and 12 months postoperatively. The results showed that there was no clinically significant difference among groups. Radiographically there was an association for the presence of internal reabsorption in the group I (FC) of 3 months to 6 months and 3 months to 12 months, and an association for the presence of pulp calcification in groups I (FC) with p=0,04 and group III (LBI+ZOE) with p=0,01 of 3 months to 12 months and 6 months to 12 months. In comparison among the groups in each period, the statistical analysis of results showed that there was an association between the formation of dentin barrier for groups I (FC) and II (CH), for groups I (FC) and IV (LBI+CH), for groups II (CH) and III (LBI+ZOE) and for groups III (LBI+ZOE) and IV (LBI+CH) in the three periods evaluation (p = 0.00). The formocresol showed the higher levels of clinical and radiografic success among the study groups, however is not associated with the formation of dentin barrier. The Low Intensity Laser showed higher levels of clinical and radiographic success with respect to internal resorption and pulp calcification compared with groups II (CH) and IV (LBI + CH), but it is also not associated with the formation of dentin barrier. Thus, it is suggested that Low Intensity Laser may be considered an alternative...

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UNLABELLED: Evidence-based dentistry is a critical evaluation, awareness of the available evidence to improve decision making about the care of individual patients and/or communities. OBJECTIVE: To systematically analyze the available scientific literature on clinical and radiographic results of two materials used in pulpotomy in primary teeth: formocresol and mineral trioxide aggregate. MATERIALS AND METHODS: It was identified relevant publications through a search of electronic databases such as MEDLINE (Ovid) and The Cochrane Library. To be included in the review, studies had to define the material used in child patients with pulp exposure by caries or tooth-alveolar trauma. RESULTS: Of the 21 articles obtained in the initial phase of the review, only 19 were available in full text and of these only met the requirements for inclusion 6 items, which were confronted, analyzed and discussed later. CONCLUSIONS: The clinical evidence available showed significant differences regarding the use of a material or another. In addition to the findings of clinical follow--radiographic and taking into account the potential toxicity of formocresol suggest the use of mineral trioxide aggregate pulpotomy of primary teeth.

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The present study was conducted to investigate the role of Formocresol (FC)-induced apoptosis and necrotic cell death in murine peritoneal macrophages (pMø). Macrophages were cultured with 1:100 FC for 2 to 24 h. The viability (trypan blue assay), cell morphology (scanning electronic microscope), and apoptotic and necrotic indexes (light and fluorescent microscopy) were determined at different scheduled times. Simultaneously, the expressions of proteins related to stress, survival, and cell death were measured by western blotting. FC-exposed macrophages exhibited maximal apoptosis from 2 to 6 h, coincident with Bax overexpression (P < 0.001). Additionally, Bcl-x(L) showed maximal expression between 12 and 24 h suggesting its survival effect in pMø. The lowest pMø viability and the increment of the necrotic rate from 4 to 12 h were observed in accordance to Fas and Hsp60 overexpressions. In summary, all the experimental data suggest that two different pathways emerge in pMø exposed to FC, one leading Bax-dependent apoptosis (2-6 h) and the other one favoring necrosis (4-18 h), related to Fas-receptor and Hsp60 stress signal.

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This study investigates the profile of teaching primary tooth pulp therapy practiced by Brazilian dental schools. A multiple-choice questionnaire was sent by e-mail to 191 dental schools in Brazil, addressed to the pediatric dentistry Chairperson. The two-part survey consisting of multiple-choice questions regarding specific materials and techniques on pulp therapies, moreover, hypothetical clinical scenarios were presented so that the respondents could guide the treatment approach. The questionnaires were returned by 46.5% of the dental schools. Ninety-five percent of surveyed schools teach IPT for the treatment of deep carious lesions in dentin and indicate the calcium hydroxide as capping material (59.3%). The direct pulp capping is taught by 68.7% of schools and calcium hydroxide (97%) was the capping material most indicated. Pulpotomy is taught in 98.7% of schools and formocresol (1:5 dilution) was the medicament of choice (50%). All schools taught pulpectomy and Iodoform paste was the filling material preferred (55%). The results showed a lack of consensus in certain modalities and techniques for primary tooth pulp therapy taught by Brazilian dental schools.

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PURPOSE: After exposing the pulp tissue, cytokines are produced that regulate the pulp inflammatory response. The dental literature, however, lacks information on the participation of primary tooth fibroblasts in this process. The purpose of this study was to verify the participation of human primary tooth pulp fibroblasts in the inflammatory process, evaluate the production of interleukin 1 beta (IL-l beta) and interleukin 8 (IL-8) from these cells. METHODS: Pulpotomy agents were applied as conditioned media on cell cultures in the following groups: (1) negative control; (2) positive control (Lipopolysaccharide -LPS); (3) calcium hydroxide (powder); (4) mineral trioxide aggregate (MTA); (5) adhesive resin; and (6) formocresol. After 24 hours in contact with the cells, the conditioned media were removed, the proteins were extracted from the cells and IL-l beta and IL-8 were quantified by ELISA (Enzyme linked immuno-sorbent assay). RESULTS: Data were analyzed by analysis of variance (P<0.05) and Tukey's test (P<0.05). It was observed that calcium hydroxide has stimulated the production of IL-l beta, without stimulating IL-8. Conversely, the adhesive resin and formocresol stimulated the production of IL-8, and did not stimulate IL-l beta. MTA stimulated both cytokines in an intermediate level when compared to the other materials. CONCLUSION: Primary tooth fibroblasts can respond immunologically, and different pulp capping materials can help in this process.

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Objetivo: Analisar o teor de formaldeído em diversas marcas de formocresol e verificar se há alteração na fórmula do produto após simulação de uso, bem como das marcas entre si. Método: Neste estudo in vitro foram utilizados quatro diferentes marcas comerciais do medicamento formocresol (Biodinâmica, Iodontec, Inodon e Iodontosul) realizando simulação de seu uso em clínica através da manipulação diária dos produtos por um período de 60 dias. A análise química foi realizada nos laboratórios da Faculdade de Química da PUCRS, com o formaldeído, principal componente com propriedade de evaporação significativa do formocresol, onde foram realizadas três análises químicas pelo método de cromatografia gasosa. Resultados: Houve diminuição no teor de formaldeído durante o período de 60 dias nas quatro marcas comerciais, sugerindo que a eficácia do produto pode ser diminuída ao longo do uso. Constatou-se também que houve diferença na quantidade inicial de formaldeído entre as marcas pesquisadas. Conclusão: A eficácia do produto pode ser diminuída ao longo do uso, porém não há evidências conclusivas, havendo a necessidade de estudos adicionais.

Objective: To analyze the formaldehyde content in different brands of formocresol and to evaluate whether there are alterations in the product formula after simulated use and among the brands. Method: This in vitro study used four commercial brands of formocresol (Biodinâmica®, Iodontec®, Inodon® and Iodontosul®) simulating its clinical use by handling these products daily during 60 days. The chemical analysis was performed at the laboratory of PUCRS's Chemistry School and focused on formaldehyde, which is formocresol's main component with Signify cant evaporation property. The analysis comprised three chemical analyses by the gaseous chromatography method. Results: There was a decrease in the formaldehyde content decreased in the 60-day period for all four brands, suggesting that the product efficiency may decrease with time. It was also observed that the initial formaldehyde content differed among the researched brands. Conclusion: The efficacy of the product may decrease with time, but the results are not conclusive, needing further research.

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