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Relationship between formocresol pulpotomies on primary teeth and enamel defects on their permanent successors
Twenty-five permanent premolars were evaluated for enamel defects. The primary molars that they succeeded had been successfully treated with a formocresol pulpotomy. A relationship between the enamel defects and the pulpotomy procedures has been found.
Relationship between form ocresol pulpotom ies on prim ary teeth and enamel defects on their perm anent successors R o n a ld J. P ru h s, DDS, MS G a ry A. O le n , DDS, MS P re m S. S h a rm a , LDS, MS, DDS, M ilw aukee
tm
H isto r ica lly , th e fo rm o creso l p u lp otom y is rec o m m en d ed as th e preferred treatm ent in th e pri m ary d en titio n , to p reserve and retain a tooth in w hich th e pulp is cariou sly in v o lv ed . T radi tio n a lly , th e s u c c e s s o f the p roced u re is b ased on a clin ica l, radiographic, and h isto lo g ic e v a l u ation o f the prim ary tooth after sign ifican t in tervals o f tim e. In our op in ion , p o ssib le e ffe c ts o f this p roced u re on th e p erm anent d en tition a lso sh ou ld b e a criterion o f s u c c e ss. T h e p u rp ose o f th e research reported h ere w a s to ev a lu a te, clin ically and rad iograph ically, the relation sh ip b etw e en fo rm o creso l p u lp o to m ies o n prim ary teeth and en am el d efec ts on their p erm an en t su c c e sso r s.
R e vie w of literatu re T h ere are n o reports in the d en tal literature about th e e ffe c ts on th e enam el o f th e p erm an en t su c c e s s o r s to prim ary teeth treated by fo rm o cre so l p u lp o to m ies. A v a ila b le reports are lim ited to the e ffe c ts on the tim e o f ex fo lia tio n o f the pri m ary teeth and on the tim e o f erup tion o f th e p erm an en t su c c e sso r . S ta r k e y 1 reported on a prim ary se co n d m olar fo llo w in g a p u lp ecto m y and su c c e ssfu l root ca n al filling. T h e perm anent su c c e sso r w a s retained lo n g er than its antim ere and w a s d eflec te d b u c 6 9 8 ■ JADA, Vol. 94, A pril 1977
ca lly . H e did not in v estig a te th e p resen ce o f e n am el d e fe c ts. W ein lan d er2 su g g ested that the treatm ent o f n o n vital tee th , e v e n th o se w ith slight b on y in v o lv e m e n t, w as n ot to o h a za rd o u s, as long as th e p atient en jo y ed g o o d health and w as a v a il ab le for regular o b serv a tio n . H o w e v e r , he said , in regard to d am age o f th e en am el o f the s u c c e s so r to o th , if the injury w a s an early o ccu rren ce, rem oval o f th e offen d in g prim ary tooth w ould not co rrect th e resu lting d am age. W einlan d er c o n ten d ed that the e x te n t o f d am a g e w ou ld b e c o n fined if norm al (radiographic) periradicular co n d ition s co u ld b e re sto red , and that the risk o f further dam age w o u ld b e nil o r m inim al, ev e n if the p u lp o to m y failed and th e prim ary tooth had to be rem o v ed . B in n s and E sco b a r3 p ro p o sed that periapical and interradicular in fe ctio n in supporting tissu es o f prim ary teeth w as a c a u sa tiv e fa cto r in en am el h y p o p la sia or d isco lo ra tio n o f perm anent to o th en a m el. T h ey reported that in tention al m ech an ical ex p o su r e o f th e p ulp s o f prim ary teeth in dogs resu lted in d isturbed en a m el form ation (h y p o p la sia and h y p o ca lcifi cation ) in th e perm anent su c c e sso r . T h e d istu rb a n ce, th ey o b serv ed , o c curred on ly if the e x p o su re or in fectio n o f the prim ary tooth took p la ce during the period o f crow n form ation o f th e perm anent su cc esso r . S h iere and F rankl4 stu d ied th e d ev elo p m en ta l
ch a n g es in th e d en tal arch es o f 503 p atien ts. A f ter exam in a tio n and evalu ation o f radiographic su rv e y s and stu d y m o d e ls, th ey ob serv ed that in fected prim ary teeth affected th e d ev elo p in g p erm an en t tee th in a variety o f w a y s. L o c a liz ed h y p o p la sia o f th e en am el w a s traced to purulent periapical le s io n s o f prim ary tee th , w h ich en cro a ch ed o n th e d ev elo p in g too th buds. T h e in v a s iv e in fe c tio n em an atin g from th e d isea sed pulp m ay h a v e ca u se d ero sio n and p erm eation o f th e p r o te c tiv e d en tal fo llic le. In ad dition , c o m p lete ex fo lia tio n o f th e too th fo llic le co u ld occu r from lo ca l inflam m ation and suppuration pro d u ced b y an in fected prim ary tooth. U sin g rh esu s m o n k ey s, K aplan and a s s o c ia te s5 stu d ied th e e ffe c ts o f inflam m ation in th e p u lp s o f prim ary tee th on th e d ev elo p in g p erm a n en t su c c e s s o r s . Inflam m ation w a s in d u ced in th e ex p erim en ta l tee th b y surgical ex p o su re o f their p u lp s. F o rty -o n e prim ary teeth in fiv e m on k ey s w er e treated . N in e te e n o f th e exp erim en tal teeth w ere in su lted further b y th e in trodu ction o f o n e drop o f h yd roch loric acid (12 N ) to th e e x p o se d p u lp s. N e c r o s is o f th e p ulp s o f prim ary tee th resu lted in relatively sm all d am age to th e p erm an en t su c c e sso r s b eca u se o f th e ten d en cy o f th e in flam m atory resp o n se to rem ain lo c a l ized . A lth ou gh e ffe c ts on th e perm anent teeth w ere n o te d , it w a s co n clu d ed that th ey w er e ir regular and u np redictab le in o ccu rren ce. T h e authors h y p o th e siz e d that if the inflam m ation p ersisted and sp read, it w a s p o ssib le that it cou ld resu lt in d e fe c ts to th e hard tissu e s o f th e perm an en t s u c c e sso r s. T h e d efec ts w o u ld m anifest th e m se lv e s as eith er a h yp op lasia or h yp o ca lcifica tion . M a tsu m iy a 6 d esign ed an exp erim en t to test th e h y p o th e sis that the treatm ent o f in fected root ca n a ls w a s im portant, n ot o n ly for th e p reserva tio n o f th e to o th itse lf, b u t a lso for the p rotection o f th e u nd erlyin g to o th germ . In the stu d y , 462 root can als in prim ary teeth o f 35 h ealth y d ogs w ere e x p o se d to th e oral ca v ity for various tim es. A p rop ortion o f the can als w a s su b seq u en tly sterilized and filled w ith various m aterials. T h e anim als w e r e k illed , and the p eriapical tissu es ex a m in ed h isto lo g ica lly . In all in sta n c e s, e v i d e n c e o f p eriap ical inflam m ation w a s p resen t; h o w e v e r , d estru ctio n o f th e en am el organ had occu rred in le s s than o n e fourth o f th e sam p le. T h e pattern o f resorption o f th e prim ary roots w as e r o siv e in nature and con sid ered abnorm al. T rea tm en t o f th e in fected can als re so lv e d the p eriapical inflam m ation; h o w e v er , th e d am age to th e too th germ w a s not repaired. It w a s co n
clu d ed that p rev en tio n and early treatm en t o f caries o f th e prim ary to o th w er e th e b e st sa fe guards again st d am age to th e u nd erlyin g p erm an en t to o th .
Methods and materials T w e n ty -fiv e p a tien ts, a g ed 12 to 17 y e a r s, w ere se le c te d fo r this stu d y . A ll had p rev io u sly sou ght den tal treatm ent at th e M arqu ette U n iv e r sity P ed o d o n tic C lin ic and w er e in clu d ed in a th esis by L u d w ig .7 L u d w ig ’s research in clu d ed a clin ica l ev a lu a tion o f 209 prim ary tee th treated w ith a o n e-v isit, fiv e-m in u te fo rm o cr eso l p u lp o to m y tech n iq u e, u sing B u c k le y ’s fo rm u la o f 19% fo rm a ld eh y d e, 35% tricresol in a v e h ic le o f 15% g ly c er in e and w ater. A ll teeth w e r e reex a m in ed at p erio d ic in tervals up to 24 m o n th s. F ifty -n in e p atien ts failed to return for ex a m in a tio n . O n e hundred and tw enty-fou r o f th e p u lp o to m ies w er e c o n sid ered su cc essfu l. S u c c e s s o f th e p ro ced u re w as ju d g ed o n th e clin ica l a b se n c e o f inflam m ation o r in fectio n in th e a d ja cen t tissu e s, a n eg a tiv e h isto ry o f pain, and th e a b se n c e o f radiographic ev id e n c e o f internal resorp tion o r in v o lv em e n t o f th e furcation o r ap ical area s. T h e p r e s e n c e o f sy ste m ic d isea se that co u ld in flu en ce d en ta l d e v elo p m en t w a s d eterm in ed b y a m ed ica l h istory that w as taken fo r ea c h p a tien t b efo re th e ex a m ination. T h e study reported h ere is a clin ica l and radiographic ev a lu ation o f th e relation sh ip b etw e en th e clin ica lly and rad iograph ically su c c e ssfu l fo rm o creso l p u lp o to m ies o n prim ary tee th in L u d w ig ’s stud y and en a m el d e fe c ts in th eir perm a n en t su c c e sso r s. T h e tee th in L u d w ig ’s sam ple that ex h ib ited th e fo llo w in g p reo p era tiv e sy m p to m s w ere ex c lu d e d from th e study: m o b ility , sp o n ta n eo u s pain, a p ical or fu rcation in v o lv e m en t, internal reso rp tio n , or th e p r e s e n c e o f a fistu lo u s tract. T h e 25 co n trol tee th w ere th e p erm an en t antim eres to the treated sid e. T h e s e tee th w er e e x am ined at th e sam e ap p o in tm en t as th o se o n the treated sid e, u sin g th e sa m e m eth od s and criteria o f exam in ation. C lin ica lly , the stu d y u sed a m eth od for ev a lu a tion o f en am el d e fe c ts and irregularities reco m m en ded b y R u le, Z a c h e rl, and P fe ffe r le .8 T h is m ethod o f ev a lu ation is b ased on th e d iv isio n o f th e cro w n to perm it a d etailed stu d y o f its ana to m ic parts. T h e labial and lingual su rfa ces w ere d ivid ed in to n ine se g m e n ts and th e o c c lu sa l sur
Pruhs— Olen— Sharma: FORMOCRESOL PULPOTOMIES. DEFECTS ON PERMANENT TEETH ■ 699
fa c e in to six . T h e labial, lingual, and o cclu sa l su rfaces w er e evalu ated for en am el d efec ts and cariou s le sio n s b y tw o in d ep en d en t exam in ers. E n a m el d e fe c ts w ere d efined as an y abnorm al ity in su rfa ce m orp h ology or co lo r. B e fo r e th e clin ical ex a m in a tio n , th e teeth w ere dried fo r a m inim um o f 1.5 m inu tes to afford m axim um v isi b ility. M o r p h o lo g ic d efects w ere d eterm in ed by p a ssin g a n o. 6 exp lorer o v er th e en tire en am el su rface o f th e to o th . A bn orm alities in c o lo r w ere d eterm in ed b y visu al exam in ation . B efo re the clin ical stu d y w a s undertaken, fiv e sam p les w ere e v a lu a ted b y tw o exam in ers to stand ard ize th e rad iograph ic criteria for future evalu ation . T h e d ata w e r e su b jected to a statistical an aly sis u sin g th e 50% probability test. T h is statistical te st w a s c h o s e n b eca u se it w as sp ec ifica lly d e sign ed fo r p aired data and a relatively sm all sam p le siz e.
Table ■ Teeth exhibiting enamel defects. All surfaces
Labial
Lingual
24 1 0
16 1 8
16 2 7
Treated side Control teeth No defect
Occlusal 11 0 14
Radiographi
b etw e en th e teeth o n th e treated and con trol sid es. E lev en o f th e tee th o n the treated sid e sh o w ed m ore en am el d e fe c ts than th e con trol teeth . N o n e o f th e tee th in th e co n tro l group sh o w ed m ore en a m el d e fe c ts than th o se o n the treated sid e. N o sign ifican t d ifferen ce ( P > .0 5 ) w a s found b e tw e e n th e tee th in th e radiographic p ortion o f th e stud y. F iv e tee th o f th e treated sid e sh o w ed m ore en a m el d efec ts than th e co n tro l teeth . N o n e o f th e co n trol tee th sh o w e d m o re en am el d e fe c ts than th o se o n the treated sid e.
C o n clu sio n
Results T h e stu d y ev a lu a ted th e relation ship b etw e en fo rm o cr eso l p u lp o to m ies on prim ary teeth and en am el d e fe c ts on their p erm an en t su c c e sso r s. T w e n ty -fiv e perm anent teeth on th e treated sid e w ere clin ica lly and radiographically com p ared to their a n tim eres for en am el d efec ts. C orrelation b e tw e e n exam in ers w as sh ow n to b e 0.9 8 radiographically and 0.9 6 clin ically . T h e T a b le sh o w s that, accord in g to th e cri teria for ev a lu a tio n o f en am el d e fe c ts, there w as a h ighly sign ifican t d ifferen ce ( P c .0 1 ) b etw e en teeth on th e treated and th e con trol sid es. M ore en am el d e fe c ts w er e sh ow n on th e treated side than o n th e co n tro l sid e in 24 o f th e 25 pairs. A h igh ly sign ifican t d ifferen ce ( P c .0 1 ) w as foun d for d e fe c ts on th e labial su rface b etw e en th e te e th o n th e treated sid e and the con trol teeth . S ix te e n te e th o n th e treated sid e had m ore en am e l-d e fe c ts than th e con trol teeth . O n ly o n e too th in th e co n tro l group w as foun d to h a v e m ore e n am el d e fe c ts th an the tee th in th e treated group. A h igh ly sign ifican t d ifferen ce ( P < .0 1 ) w as fou n d fo r d e fe c ts on the labial su rface b e tw e e n th e tee th o n th e treated sid e and the con trol teeth . S ix te e n te e th on th e treated sid e had m ore enam h a v e m o re en am el d efec ts than th e con trol teeth . T w o tee th on th e con trol sid e sh o w e d m ore en am el d e fe c ts than th o se on th e treated sid e. A h igh ly sign ifican t d ifferen ce (jP < .01) a lso w a s fo u n d for d efec ts on the o cc lu sa l su rface
7 00 ■ JADA, Vol. 94, April 1977
T h e resu lts o f this stu d y in d ica te a d efin ite rela tio n sh ip b e tw e e n fo rm o creso l p u lp o to m ies in prim ary teeth and en a m el d efec ts o n their p erm an en t su c c e s so r s. T h is in form ation sh ould be co n sid ered b efo re th e fo rm o creso l p u lp otom y is attem p ted in th e prim ary d en tition .
Dr. Pruhs is associate professor and chairman of the depart ment of pedodontics at Marquette University School of Dentistry, 604 N 16th St, Milwaukee, 53233. Dr. Olen, formerly a graduate student at Marquette, is practicing pedodontics in San Diego. Dr. Sharma is professor of pedodontics and assistant dean at Marquette University School of Dentistry. Address requests for reprints to Dr. Pruhs. 1. Starkey, P.E. Pulpectomy and root canal filling in a primary molar: report of a case. J Dent Child 40:213 May-June 1973. 2. Weinlander, G.H. Clinical effect of formaldehyde prepara tions in pulpotomy for primary molars. J Can Dent Assoc 37:154 April 1971. 3. Binns, W.H., Jr., and Escobar, A. Defects in permanent teeth following pulp exposure in primary teeth. J Dent Child 34:4 Jan 1967. 4. Shiere, F.R., and Frankl, S.N. The effect of deciduous tooth infection on permanent teeth. J Dent Prog 2:59 Oct 1961. 5. Kaplan, N.L.; Zach, L.; and Goldsmith, E.D. Effects of pulpal exposure in the primary dentition on the succedaneous teeth. J Dent Child 34:237 July 1967. 6. Matsumiya, S. Experimental pathological study on the effect of treatment of infected root canals in deciduous teeth on the growth of the permanent tooth germ. Int Dent J 18:546 Sept 1968. 7. Ludwig, R.J. A formocresol pulpotomy technique for the primary dentition, thesis. Marquette University, Milwaukee, Jan 1968. 8. Rule, J.T.; Zacherl, W.A.: and Pfefferle, A.M. The relationship between ankylosed primary molars and multiple enamel defects. J Dent Child 39:29 Jan-Feb 1972.
5 0 20
Relationship between form ocresol pulpotom ies on prim ary teeth and enamel defects on their perm anent successors R o n a ld J. P ru h s, DDS, MS G a ry A. O le n , DDS, MS P re m S. S h a rm a , LDS, MS, DDS, M ilw aukee
tm
H isto r ica lly , th e fo rm o creso l p u lp otom y is rec o m m en d ed as th e preferred treatm ent in th e pri m ary d en titio n , to p reserve and retain a tooth in w hich th e pulp is cariou sly in v o lv ed . T radi tio n a lly , th e s u c c e s s o f the p roced u re is b ased on a clin ica l, radiographic, and h isto lo g ic e v a l u ation o f the prim ary tooth after sign ifican t in tervals o f tim e. In our op in ion , p o ssib le e ffe c ts o f this p roced u re on th e p erm anent d en tition a lso sh ou ld b e a criterion o f s u c c e ss. T h e p u rp ose o f th e research reported h ere w a s to ev a lu a te, clin ically and rad iograph ically, the relation sh ip b etw e en fo rm o creso l p u lp o to m ies o n prim ary teeth and en am el d efec ts on their p erm an en t su c c e sso r s.
R e vie w of literatu re T h ere are n o reports in the d en tal literature about th e e ffe c ts on th e enam el o f th e p erm an en t su c c e s s o r s to prim ary teeth treated by fo rm o cre so l p u lp o to m ies. A v a ila b le reports are lim ited to the e ffe c ts on the tim e o f ex fo lia tio n o f the pri m ary teeth and on the tim e o f erup tion o f th e p erm an en t su c c e sso r . S ta r k e y 1 reported on a prim ary se co n d m olar fo llo w in g a p u lp ecto m y and su c c e ssfu l root ca n al filling. T h e perm anent su c c e sso r w a s retained lo n g er than its antim ere and w a s d eflec te d b u c 6 9 8 ■ JADA, Vol. 94, A pril 1977
ca lly . H e did not in v estig a te th e p resen ce o f e n am el d e fe c ts. W ein lan d er2 su g g ested that the treatm ent o f n o n vital tee th , e v e n th o se w ith slight b on y in v o lv e m e n t, w as n ot to o h a za rd o u s, as long as th e p atient en jo y ed g o o d health and w as a v a il ab le for regular o b serv a tio n . H o w e v e r , he said , in regard to d am age o f th e en am el o f the s u c c e s so r to o th , if the injury w a s an early o ccu rren ce, rem oval o f th e offen d in g prim ary tooth w ould not co rrect th e resu lting d am age. W einlan d er c o n ten d ed that the e x te n t o f d am a g e w ou ld b e c o n fined if norm al (radiographic) periradicular co n d ition s co u ld b e re sto red , and that the risk o f further dam age w o u ld b e nil o r m inim al, ev e n if the p u lp o to m y failed and th e prim ary tooth had to be rem o v ed . B in n s and E sco b a r3 p ro p o sed that periapical and interradicular in fe ctio n in supporting tissu es o f prim ary teeth w as a c a u sa tiv e fa cto r in en am el h y p o p la sia or d isco lo ra tio n o f perm anent to o th en a m el. T h ey reported that in tention al m ech an ical ex p o su r e o f th e p ulp s o f prim ary teeth in dogs resu lted in d isturbed en a m el form ation (h y p o p la sia and h y p o ca lcifi cation ) in th e perm anent su c c e sso r . T h e d istu rb a n ce, th ey o b serv ed , o c curred on ly if the e x p o su re or in fectio n o f the prim ary tooth took p la ce during the period o f crow n form ation o f th e perm anent su cc esso r . S h iere and F rankl4 stu d ied th e d ev elo p m en ta l
ch a n g es in th e d en tal arch es o f 503 p atien ts. A f ter exam in a tio n and evalu ation o f radiographic su rv e y s and stu d y m o d e ls, th ey ob serv ed that in fected prim ary teeth affected th e d ev elo p in g p erm an en t tee th in a variety o f w a y s. L o c a liz ed h y p o p la sia o f th e en am el w a s traced to purulent periapical le s io n s o f prim ary tee th , w h ich en cro a ch ed o n th e d ev elo p in g too th buds. T h e in v a s iv e in fe c tio n em an atin g from th e d isea sed pulp m ay h a v e ca u se d ero sio n and p erm eation o f th e p r o te c tiv e d en tal fo llic le. In ad dition , c o m p lete ex fo lia tio n o f th e too th fo llic le co u ld occu r from lo ca l inflam m ation and suppuration pro d u ced b y an in fected prim ary tooth. U sin g rh esu s m o n k ey s, K aplan and a s s o c ia te s5 stu d ied th e e ffe c ts o f inflam m ation in th e p u lp s o f prim ary tee th on th e d ev elo p in g p erm a n en t su c c e s s o r s . Inflam m ation w a s in d u ced in th e ex p erim en ta l tee th b y surgical ex p o su re o f their p u lp s. F o rty -o n e prim ary teeth in fiv e m on k ey s w er e treated . N in e te e n o f th e exp erim en tal teeth w ere in su lted further b y th e in trodu ction o f o n e drop o f h yd roch loric acid (12 N ) to th e e x p o se d p u lp s. N e c r o s is o f th e p ulp s o f prim ary tee th resu lted in relatively sm all d am age to th e p erm an en t su c c e sso r s b eca u se o f th e ten d en cy o f th e in flam m atory resp o n se to rem ain lo c a l ized . A lth ou gh e ffe c ts on th e perm anent teeth w ere n o te d , it w a s co n clu d ed that th ey w er e ir regular and u np redictab le in o ccu rren ce. T h e authors h y p o th e siz e d that if the inflam m ation p ersisted and sp read, it w a s p o ssib le that it cou ld resu lt in d e fe c ts to th e hard tissu e s o f th e perm an en t s u c c e sso r s. T h e d efec ts w o u ld m anifest th e m se lv e s as eith er a h yp op lasia or h yp o ca lcifica tion . M a tsu m iy a 6 d esign ed an exp erim en t to test th e h y p o th e sis that the treatm ent o f in fected root ca n a ls w a s im portant, n ot o n ly for th e p reserva tio n o f th e to o th itse lf, b u t a lso for the p rotection o f th e u nd erlyin g to o th germ . In the stu d y , 462 root can als in prim ary teeth o f 35 h ealth y d ogs w ere e x p o se d to th e oral ca v ity for various tim es. A p rop ortion o f the can als w a s su b seq u en tly sterilized and filled w ith various m aterials. T h e anim als w e r e k illed , and the p eriapical tissu es ex a m in ed h isto lo g ica lly . In all in sta n c e s, e v i d e n c e o f p eriap ical inflam m ation w a s p resen t; h o w e v e r , d estru ctio n o f th e en am el organ had occu rred in le s s than o n e fourth o f th e sam p le. T h e pattern o f resorption o f th e prim ary roots w as e r o siv e in nature and con sid ered abnorm al. T rea tm en t o f th e in fected can als re so lv e d the p eriapical inflam m ation; h o w e v er , th e d am age to th e too th germ w a s not repaired. It w a s co n
clu d ed that p rev en tio n and early treatm en t o f caries o f th e prim ary to o th w er e th e b e st sa fe guards again st d am age to th e u nd erlyin g p erm an en t to o th .
Methods and materials T w e n ty -fiv e p a tien ts, a g ed 12 to 17 y e a r s, w ere se le c te d fo r this stu d y . A ll had p rev io u sly sou ght den tal treatm ent at th e M arqu ette U n iv e r sity P ed o d o n tic C lin ic and w er e in clu d ed in a th esis by L u d w ig .7 L u d w ig ’s research in clu d ed a clin ica l ev a lu a tion o f 209 prim ary tee th treated w ith a o n e-v isit, fiv e-m in u te fo rm o cr eso l p u lp o to m y tech n iq u e, u sing B u c k le y ’s fo rm u la o f 19% fo rm a ld eh y d e, 35% tricresol in a v e h ic le o f 15% g ly c er in e and w ater. A ll teeth w e r e reex a m in ed at p erio d ic in tervals up to 24 m o n th s. F ifty -n in e p atien ts failed to return for ex a m in a tio n . O n e hundred and tw enty-fou r o f th e p u lp o to m ies w er e c o n sid ered su cc essfu l. S u c c e s s o f th e p ro ced u re w as ju d g ed o n th e clin ica l a b se n c e o f inflam m ation o r in fectio n in th e a d ja cen t tissu e s, a n eg a tiv e h isto ry o f pain, and th e a b se n c e o f radiographic ev id e n c e o f internal resorp tion o r in v o lv em e n t o f th e furcation o r ap ical area s. T h e p r e s e n c e o f sy ste m ic d isea se that co u ld in flu en ce d en ta l d e v elo p m en t w a s d eterm in ed b y a m ed ica l h istory that w as taken fo r ea c h p a tien t b efo re th e ex a m ination. T h e study reported h ere is a clin ica l and radiographic ev a lu ation o f th e relation sh ip b etw e en th e clin ica lly and rad iograph ically su c c e ssfu l fo rm o creso l p u lp o to m ies o n prim ary tee th in L u d w ig ’s stud y and en a m el d e fe c ts in th eir perm a n en t su c c e sso r s. T h e tee th in L u d w ig ’s sam ple that ex h ib ited th e fo llo w in g p reo p era tiv e sy m p to m s w ere ex c lu d e d from th e study: m o b ility , sp o n ta n eo u s pain, a p ical or fu rcation in v o lv e m en t, internal reso rp tio n , or th e p r e s e n c e o f a fistu lo u s tract. T h e 25 co n trol tee th w ere th e p erm an en t antim eres to the treated sid e. T h e s e tee th w er e e x am ined at th e sam e ap p o in tm en t as th o se o n the treated sid e, u sin g th e sa m e m eth od s and criteria o f exam in ation. C lin ica lly , the stu d y u sed a m eth od for ev a lu a tion o f en am el d e fe c ts and irregularities reco m m en ded b y R u le, Z a c h e rl, and P fe ffe r le .8 T h is m ethod o f ev a lu ation is b ased on th e d iv isio n o f th e cro w n to perm it a d etailed stu d y o f its ana to m ic parts. T h e labial and lingual su rfa ces w ere d ivid ed in to n ine se g m e n ts and th e o c c lu sa l sur
Pruhs— Olen— Sharma: FORMOCRESOL PULPOTOMIES. DEFECTS ON PERMANENT TEETH ■ 699
fa c e in to six . T h e labial, lingual, and o cclu sa l su rfaces w er e evalu ated for en am el d efec ts and cariou s le sio n s b y tw o in d ep en d en t exam in ers. E n a m el d e fe c ts w ere d efined as an y abnorm al ity in su rfa ce m orp h ology or co lo r. B e fo r e th e clin ical ex a m in a tio n , th e teeth w ere dried fo r a m inim um o f 1.5 m inu tes to afford m axim um v isi b ility. M o r p h o lo g ic d efects w ere d eterm in ed by p a ssin g a n o. 6 exp lorer o v er th e en tire en am el su rface o f th e to o th . A bn orm alities in c o lo r w ere d eterm in ed b y visu al exam in ation . B efo re the clin ical stu d y w a s undertaken, fiv e sam p les w ere e v a lu a ted b y tw o exam in ers to stand ard ize th e rad iograph ic criteria for future evalu ation . T h e d ata w e r e su b jected to a statistical an aly sis u sin g th e 50% probability test. T h is statistical te st w a s c h o s e n b eca u se it w as sp ec ifica lly d e sign ed fo r p aired data and a relatively sm all sam p le siz e.
Table ■ Teeth exhibiting enamel defects. All surfaces
Labial
Lingual
24 1 0
16 1 8
16 2 7
Treated side Control teeth No defect
Occlusal 11 0 14
Radiographi
b etw e en th e teeth o n th e treated and con trol sid es. E lev en o f th e tee th o n the treated sid e sh o w ed m ore en am el d e fe c ts than th e con trol teeth . N o n e o f th e tee th in th e co n tro l group sh o w ed m ore en a m el d e fe c ts than th o se o n the treated sid e. N o sign ifican t d ifferen ce ( P > .0 5 ) w a s found b e tw e e n th e tee th in th e radiographic p ortion o f th e stud y. F iv e tee th o f th e treated sid e sh o w ed m ore en a m el d efec ts than th e co n tro l teeth . N o n e o f th e co n trol tee th sh o w e d m o re en am el d e fe c ts than th o se o n the treated sid e.
C o n clu sio n
Results T h e stu d y ev a lu a ted th e relation ship b etw e en fo rm o cr eso l p u lp o to m ies on prim ary teeth and en am el d e fe c ts on their p erm an en t su c c e sso r s. T w e n ty -fiv e perm anent teeth on th e treated sid e w ere clin ica lly and radiographically com p ared to their a n tim eres for en am el d efec ts. C orrelation b e tw e e n exam in ers w as sh ow n to b e 0.9 8 radiographically and 0.9 6 clin ically . T h e T a b le sh o w s that, accord in g to th e cri teria for ev a lu a tio n o f en am el d e fe c ts, there w as a h ighly sign ifican t d ifferen ce ( P c .0 1 ) b etw e en teeth on th e treated and th e con trol sid es. M ore en am el d e fe c ts w er e sh ow n on th e treated side than o n th e co n tro l sid e in 24 o f th e 25 pairs. A h igh ly sign ifican t d ifferen ce ( P c .0 1 ) w as foun d for d e fe c ts on th e labial su rface b etw e en th e te e th o n th e treated sid e and the con trol teeth . S ix te e n te e th o n th e treated sid e had m ore en am e l-d e fe c ts than th e con trol teeth . O n ly o n e too th in th e co n tro l group w as foun d to h a v e m ore e n am el d e fe c ts th an the tee th in th e treated group. A h igh ly sign ifican t d ifferen ce ( P < .0 1 ) w as fou n d fo r d e fe c ts on the labial su rface b e tw e e n th e tee th o n th e treated sid e and the con trol teeth . S ix te e n te e th on th e treated sid e had m ore enam h a v e m o re en am el d efec ts than th e con trol teeth . T w o tee th on th e con trol sid e sh o w e d m ore en am el d e fe c ts than th o se on th e treated sid e. A h igh ly sign ifican t d ifferen ce (jP < .01) a lso w a s fo u n d for d efec ts on the o cc lu sa l su rface
7 00 ■ JADA, Vol. 94, April 1977
T h e resu lts o f this stu d y in d ica te a d efin ite rela tio n sh ip b e tw e e n fo rm o creso l p u lp o to m ies in prim ary teeth and en a m el d efec ts o n their p erm an en t su c c e s so r s. T h is in form ation sh ould be co n sid ered b efo re th e fo rm o creso l p u lp otom y is attem p ted in th e prim ary d en tition .
Dr. Pruhs is associate professor and chairman of the depart ment of pedodontics at Marquette University School of Dentistry, 604 N 16th St, Milwaukee, 53233. Dr. Olen, formerly a graduate student at Marquette, is practicing pedodontics in San Diego. Dr. Sharma is professor of pedodontics and assistant dean at Marquette University School of Dentistry. Address requests for reprints to Dr. Pruhs. 1. Starkey, P.E. Pulpectomy and root canal filling in a primary molar: report of a case. J Dent Child 40:213 May-June 1973. 2. Weinlander, G.H. Clinical effect of formaldehyde prepara tions in pulpotomy for primary molars. J Can Dent Assoc 37:154 April 1971. 3. Binns, W.H., Jr., and Escobar, A. Defects in permanent teeth following pulp exposure in primary teeth. J Dent Child 34:4 Jan 1967. 4. Shiere, F.R., and Frankl, S.N. The effect of deciduous tooth infection on permanent teeth. J Dent Prog 2:59 Oct 1961. 5. Kaplan, N.L.; Zach, L.; and Goldsmith, E.D. Effects of pulpal exposure in the primary dentition on the succedaneous teeth. J Dent Child 34:237 July 1967. 6. Matsumiya, S. Experimental pathological study on the effect of treatment of infected root canals in deciduous teeth on the growth of the permanent tooth germ. Int Dent J 18:546 Sept 1968. 7. Ludwig, R.J. A formocresol pulpotomy technique for the primary dentition, thesis. Marquette University, Milwaukee, Jan 1968. 8. Rule, J.T.; Zacherl, W.A.: and Pfefferle, A.M. The relationship between ankylosed primary molars and multiple enamel defects. J Dent Child 39:29 Jan-Feb 1972.
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