Calcium hydroxide effective for partial pulpectomy in primary molars

anatomy of teeth

Pulpotomy  is one of a number of approaches (indirect pulp capping, direct pulp capping, pulpotomy, pulpectomy) for managing carious lesions approaching the pulp of primary teeth with the aim of retaining  the tooth in a symptom free state until it is lost naturally thus avoiding an extraction.  Formocresol has been used for a number of years  but issues have been raised regarding its toxicity.  The aim of this trial was to compare the effectiveness of  Calcium hydroxide [Ca(OH)2] partial pulpectomy  (PP)  against  formocresol pulpotomy (FP) for the treatment of treatment of pulpally exposed lower primary molars.

Patient attending a paediatric dental department were randomised to  randomly assigned to  PP or FP treatment.  All teeth were treated under local anaesthesia and rubber dam. Clinical and radiographic evaluations at six-monthly intervals  were conducted by a masked investigator.

86 lower primary molars from 58 children were treated and they found:-

  •  The success rates for the two treatments at each 6-month interval were not different (P ‡ 0.05).
Calcium Hydroxide partial pulpectomy (PP)
% success
Formocresol pulpotomy
(FP)
% success
6 months95.3%92.7%
36 months 75.0%74.2%
  • The most frequent failure was internal resorption, affecting five FP teeth and three PP teeth.

The authors concluded

 Considering the favourable clinical and radiographic success rate of PP and the potentially toxic effects of formocresol leads us to recommend the use of PP instead of FP in primary teeth with deep carious lesions.

Related reviews  and guidelines

Scottish Dental Clinical Effectiveness Programme (SDCEP) . Prevention and Management of Dental Caries in Children.  Chapter 9. pages 54-57.  2010

American Academy of Pediatric Dentistry (AAPD). Guideline on pulp therapy for primary and immature permanent teeth. Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2009. 8 p. [107 references]

Nadin G, Goel BR, Yeung A, Glenny AM. Pulp treatment for extensive decay in primary teeth. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003220. DOI: 10.1002/14651858.CD003220.

 

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Derek

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Glasgow Dental Hospital. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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