- Email: [email protected]
Pulpotomy medicaments
additional anesthetic was required. With A100, the visualization of the surgical field was rated clear 83.3% of the time; with A200 it was rated clear 59.5% of the time. The blood loss was better than expected 85.7% of the time with A100 and 71.4% of the time with A200. The difference was statistically significant. In addition, blood loss was significantly less with A100 than with A200 (54.9 mL vs 70.2 mL, respectively). The fall in pulse rate from preoperatively to postoperatively differed significantly between the A100 and A200 formulations, with a fall of 6.8 beats/minute for A100 and 3.7 beats/minute for A200. Some statistically significant cardiovascular findings occurred in each session, affecting heart rate, diastolic blood pressure, and systolic blood pressure. However, overall the changes in cardiovascular function were minor and carried little clinical significance. Discussion.—Both of the articaine/epinephrine formulations provided adequate anesthesia for the surgical procedures. Visualization of the surgical field and blood loss values were better with the A100 formulation than with the A200 formulation. Patients who can tolerate the higher concentration of epinephrine may benefit from the better
visualization of the surgical field and the diminished blood loss when the A100 formulation is used.
Clinical Significance.—In this study, both solutions provided adequate pain control. With the admonition to critically evaluate the patient’s physical ability to tolerate an increased dose of epinephrine, the authors concluded that the 1:100,000 formulation afforded better hemostasis, and thus better visualization of the operating field, than the 1:200,000.
Moore PA, Doll B, Delie RA, et al: Hemostatic and anesthetic efficacy of 4% articaine HCl with 1:200,000 epinephrine and 4% articaine HCl with 1:100,000 epinephrine when administered intraorally for periodontal surgery. J Periodontol 78:247-253, 2007. Reprints available from PA Moore, Dept of Anesthesiology, Oral Health Science Inst, Univ of Pittsburgh School of Dental Medicine, 552 Salk Hall, Pittsburgh, PA 15261; fax: 412/383-8662; e-mail: [email protected]
Pediatric Dentistry Pulpotomy medicaments Background.—When children have carious molars, extraction is not recommended because of the space loss, blocked out permanent teeth, and eating difficulties that result. Pulpotomy of the carious molar is the approach most often chosen. Formocresol is the pulpotomy agent usually chosen, but it has the drawbacks of being distributed systemically, inducing a pulpal inflammatory response, being cytotoxic, and having carcinogenic potential. Ferric sulfate (FeSO4) is an alternative that also has high clinical success rates. Both these agents produce severe inflammatory responses, however. A promising alternative is sodium hypochlorite (NaOCl), which has been used as an irrigant for permanent tooth root canal treatment. It offers very good antimicrobial efficacy with no significant pulpal irritation. Five percent NaOCl was shown to act essentially on the surface, affecting deeper pulpal tissues only minimally. The effectiveness of FeSO4 and NaOCl as pulpotomy agents was compared in severely decayed primary molars. Methods.—Twenty-three healthy children ages 4 to 9 were recruited. All had at least 2 primary molars that needed pulpotomy. They were treated with either NaOCl or FeSO4 and restoration with IRM base and a stainless steel crown. Visual inspection was used to confirm the complete removal of the pulp tissue down to the canal orifices. Blood
loss was controlled through the application of pressure for no more than 5 minutes, which is the midpoint for the normal bleeding time range of 1 to 9.5 minutes. Complete hemostasis was required. Patients in the FeSO4 group had the medicament delivered to the pulp chamber via a syringe with a brush tip that was used to rub without pressure for 15 seconds. The 5% NaOCl was delivered via a soaked cotton pellet (not dried) placed in the chamber for 30 seconds. The solutions were both rinsed with water and the sites carefully checked to ensure that no clot was present. If bleeding resumed, the tooth was not used in the study. Follow-up included clinical and radiographic assessments immediately after the procedure and 6 and 12 months later. Clinical findings of mobility, swelling, fistula, or history of spontaneous pain were deemed a clinical failure; radiographic changes without clinical symptoms constituted a radiographic failure. Results.—All the NaOCl and all the FeSO4 pulpotomies achieved clinical success after 6 months (Table 2). Two teeth (same patient) in the NaOCl group exfoliated by the 12month assessment, but the remainder of the NaOCl group teeth demonstrated no clinical pathology or symptoms. Eighty-five percent of the FeSO4 group teeth were also asymptomatic. Two FeSO4 group second primary molars
Volume 52
Issue 5
2007
297
Table 2.—Clinical and Radiographic Success Rates for NaOCl and FeSO4 Pulpotomies at 6 and 12 Months Clinical Treatment
FeSO4 NaOCl Total
6 mos
Radiographic 12 mos
6 mos
Overall* 12 mos
6 mos
12 mos
S
F
S
F
S
F
S
F
S
F
S
F
28 (100%) 32 (100%) 60
0 0 0
11 (85%) 14 (100%) 25
2 (15%) 0 2
19 (68%) 29 (91%) 48
9y (32%) 3 (9%) 12
8 (62%) 11 (79%) 19
5z (38%) 3x (21%) 8
84% 96%
16% 5%
74% 90%
27% 11%
Abbreviations: S, Success; F, failure. (Courtesy of Vargas KG, Packham B, Lowman D: Preliminary evaluation of sodium hypochlorite for pulpotomies in primary molars. Pediatr Dent 28:511-517, 2006.) * % clinical success þ % radiographic success O 2. y Significantly different, Fischer’s exact, P = .050. z 2 of the 5 radiographic failures were new.
developed problems; 1 developed gingival inflammation with bleeding and the other had a fistula of the buccal mucosa.
molars. The most common radiographic problem seen with both medicaments was internal resorption, which developed after 6 months and after 12 months.
After 6 months 32% of the FeSO4 teeth and 9% of the NaOCl teeth had pathologic changes seen radiographically. Internal resorption occurred in 8 of the FeSO4 teeth and furcation involvement in 1. Two NaOCl teeth developed internal resorption and 1 had furcation involvement. The radiographic success rates for FeSO4 and NaOCl at 6 months were 68% and 91%, respectively. Those at 12 months were 62% and 79%, respectively.
Clinical Significance.—Suggested as an alternative to formocresol, FeSO4 also produces pulpal necrosis. In this study NaOCl outperformed FeSO4 as a pulpotomy agent. The most common result of what failures did occur was internal resorption.
The overall success rates at 6 months for the NaOCl and FeSO4 teeth were 84% and 96%, respectively. After 12 months the rates were 74% and 90%, respectively.
Vargas KG, Packham B, Lowman D: Preliminary evaluation of sodium hypochlorite for pulpotomies in primary molars. Pediatr Dent 28:511-517, 2006
Discussion.—The findings support the use of NaOCl rather than FeSO4 as a pulpotomy medicament in primary
Reprints available from K Vargas; e-mail: kaaren-g-vargas@ uiowa.edu
Periodontics Microbiological effects of scaling and root planing approaches Background.—A single course of scaling and root planing has not significantly changed the numbers of spirochetes and motile rods over the course of 8 weeks. In addition, black-pigmented Bacteroides species have been found subgingivally in the periodontal pocket and at various other sites in the oral cavity. As a result, one-stage full-mouth disinfection techniques were developed to prevent bacterial recolonization from intraoral niches that have escaped treatment. None of the studies of these full-mouth strategies addressed the early microbiological changes that occur in treated sites in an oral cavity with remaining, untreated periodontal pockets. Full-mouth and quadrantwise
298
Dental Abstracts
strategies were compared with respect to both early microbiological changes and long-term effects. Methods.—The 20 patients with chronic periodontitis were randomly assigned to two groups. The test group was treated in two sessions with subgingival scaling and root planing within 24 hours (FMRP). The control group received quadrant by quadrant treatment in four sessions 1 week apart (QRP). The two deepest pockets of the maxillary right quadrant were tested for microbiological status immediately before treatment, after 1 day and after 1, 2, 4, 8, 12, and 24 weeks. Real-time polymerase chain reaction
visualization of the surgical field and the diminished blood loss when the A100 formulation is used.
Clinical Significance.—In this study, both solutions provided adequate pain control. With the admonition to critically evaluate the patient’s physical ability to tolerate an increased dose of epinephrine, the authors concluded that the 1:100,000 formulation afforded better hemostasis, and thus better visualization of the operating field, than the 1:200,000.
Moore PA, Doll B, Delie RA, et al: Hemostatic and anesthetic efficacy of 4% articaine HCl with 1:200,000 epinephrine and 4% articaine HCl with 1:100,000 epinephrine when administered intraorally for periodontal surgery. J Periodontol 78:247-253, 2007. Reprints available from PA Moore, Dept of Anesthesiology, Oral Health Science Inst, Univ of Pittsburgh School of Dental Medicine, 552 Salk Hall, Pittsburgh, PA 15261; fax: 412/383-8662; e-mail: [email protected]
Pediatric Dentistry Pulpotomy medicaments Background.—When children have carious molars, extraction is not recommended because of the space loss, blocked out permanent teeth, and eating difficulties that result. Pulpotomy of the carious molar is the approach most often chosen. Formocresol is the pulpotomy agent usually chosen, but it has the drawbacks of being distributed systemically, inducing a pulpal inflammatory response, being cytotoxic, and having carcinogenic potential. Ferric sulfate (FeSO4) is an alternative that also has high clinical success rates. Both these agents produce severe inflammatory responses, however. A promising alternative is sodium hypochlorite (NaOCl), which has been used as an irrigant for permanent tooth root canal treatment. It offers very good antimicrobial efficacy with no significant pulpal irritation. Five percent NaOCl was shown to act essentially on the surface, affecting deeper pulpal tissues only minimally. The effectiveness of FeSO4 and NaOCl as pulpotomy agents was compared in severely decayed primary molars. Methods.—Twenty-three healthy children ages 4 to 9 were recruited. All had at least 2 primary molars that needed pulpotomy. They were treated with either NaOCl or FeSO4 and restoration with IRM base and a stainless steel crown. Visual inspection was used to confirm the complete removal of the pulp tissue down to the canal orifices. Blood
loss was controlled through the application of pressure for no more than 5 minutes, which is the midpoint for the normal bleeding time range of 1 to 9.5 minutes. Complete hemostasis was required. Patients in the FeSO4 group had the medicament delivered to the pulp chamber via a syringe with a brush tip that was used to rub without pressure for 15 seconds. The 5% NaOCl was delivered via a soaked cotton pellet (not dried) placed in the chamber for 30 seconds. The solutions were both rinsed with water and the sites carefully checked to ensure that no clot was present. If bleeding resumed, the tooth was not used in the study. Follow-up included clinical and radiographic assessments immediately after the procedure and 6 and 12 months later. Clinical findings of mobility, swelling, fistula, or history of spontaneous pain were deemed a clinical failure; radiographic changes without clinical symptoms constituted a radiographic failure. Results.—All the NaOCl and all the FeSO4 pulpotomies achieved clinical success after 6 months (Table 2). Two teeth (same patient) in the NaOCl group exfoliated by the 12month assessment, but the remainder of the NaOCl group teeth demonstrated no clinical pathology or symptoms. Eighty-five percent of the FeSO4 group teeth were also asymptomatic. Two FeSO4 group second primary molars
Volume 52
Issue 5
2007
297
Table 2.—Clinical and Radiographic Success Rates for NaOCl and FeSO4 Pulpotomies at 6 and 12 Months Clinical Treatment
FeSO4 NaOCl Total
6 mos
Radiographic 12 mos
6 mos
Overall* 12 mos
6 mos
12 mos
S
F
S
F
S
F
S
F
S
F
S
F
28 (100%) 32 (100%) 60
0 0 0
11 (85%) 14 (100%) 25
2 (15%) 0 2
19 (68%) 29 (91%) 48
9y (32%) 3 (9%) 12
8 (62%) 11 (79%) 19
5z (38%) 3x (21%) 8
84% 96%
16% 5%
74% 90%
27% 11%
Abbreviations: S, Success; F, failure. (Courtesy of Vargas KG, Packham B, Lowman D: Preliminary evaluation of sodium hypochlorite for pulpotomies in primary molars. Pediatr Dent 28:511-517, 2006.) * % clinical success þ % radiographic success O 2. y Significantly different, Fischer’s exact, P = .050. z 2 of the 5 radiographic failures were new.
developed problems; 1 developed gingival inflammation with bleeding and the other had a fistula of the buccal mucosa.
molars. The most common radiographic problem seen with both medicaments was internal resorption, which developed after 6 months and after 12 months.
After 6 months 32% of the FeSO4 teeth and 9% of the NaOCl teeth had pathologic changes seen radiographically. Internal resorption occurred in 8 of the FeSO4 teeth and furcation involvement in 1. Two NaOCl teeth developed internal resorption and 1 had furcation involvement. The radiographic success rates for FeSO4 and NaOCl at 6 months were 68% and 91%, respectively. Those at 12 months were 62% and 79%, respectively.
Clinical Significance.—Suggested as an alternative to formocresol, FeSO4 also produces pulpal necrosis. In this study NaOCl outperformed FeSO4 as a pulpotomy agent. The most common result of what failures did occur was internal resorption.
The overall success rates at 6 months for the NaOCl and FeSO4 teeth were 84% and 96%, respectively. After 12 months the rates were 74% and 90%, respectively.
Vargas KG, Packham B, Lowman D: Preliminary evaluation of sodium hypochlorite for pulpotomies in primary molars. Pediatr Dent 28:511-517, 2006
Discussion.—The findings support the use of NaOCl rather than FeSO4 as a pulpotomy medicament in primary
Reprints available from K Vargas; e-mail: kaaren-g-vargas@ uiowa.edu
Periodontics Microbiological effects of scaling and root planing approaches Background.—A single course of scaling and root planing has not significantly changed the numbers of spirochetes and motile rods over the course of 8 weeks. In addition, black-pigmented Bacteroides species have been found subgingivally in the periodontal pocket and at various other sites in the oral cavity. As a result, one-stage full-mouth disinfection techniques were developed to prevent bacterial recolonization from intraoral niches that have escaped treatment. None of the studies of these full-mouth strategies addressed the early microbiological changes that occur in treated sites in an oral cavity with remaining, untreated periodontal pockets. Full-mouth and quadrantwise
298
Dental Abstracts
strategies were compared with respect to both early microbiological changes and long-term effects. Methods.—The 20 patients with chronic periodontitis were randomly assigned to two groups. The test group was treated in two sessions with subgingival scaling and root planing within 24 hours (FMRP). The control group received quadrant by quadrant treatment in four sessions 1 week apart (QRP). The two deepest pockets of the maxillary right quadrant were tested for microbiological status immediately before treatment, after 1 day and after 1, 2, 4, 8, 12, and 24 weeks. Real-time polymerase chain reaction