Pulpotomy Medicament: A Review of Literature
Soranye A. Hernandez *1, Patricia Rosario Escajadillo Delgado 2
1. DDS, Universidad Central Del Este, UCE, San Pedro De Macoris, Dominican Republic.
2. DDS, Inca Garcilaso de la Vega University, Lima Peru
Corresponding Author: Soranye A. Hernandez, DDS, Universidad Central Del Este, UCE, San Pedro De Macoris, Dominican Republic.
Copy Right: © 2023 Soranye A. Hernandez, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received Date: April 08, 2022
Published Date: April 20, 2022
Abstract
Dental caries, a progressive bacterial damage to teeth that results in mineral loss, begins on the tooth's outer surface and can ultimately spread through the dentin to the pulp, compromising the tooth's vitality. Vital pulp therapy has increasingly been viewed as a minimally intrusive alternative to the standard root canal procedure for the management of teeth with stimulated pulps. According to the literature, pulpotomy is one of the crucial pulp therapy methods used to preserve severely decayed primary teeth that lack radicular pathology but have extensive caries; if this procedure is not carried out, the teeth will eventually need to be extracted. The gold standard among pulpotomy medications is still formocresol (FC), which has been documented in the literature. Despite the high success rate, there are a number of issues with FC use, including its potential for mutagenic, carcinogenic, and allergic effects. Identifying the materials used in pulpotomy is the goal of this literature analysis.
Keyword: Pulpotomy, Medicaments, Primary Teeth
Introduction
The preferred clinical treatment for primary molars with exposed pulp is vital pulpotomy. The surgical excision or amputation of the coronal pulp of the vital tooth is known as a pulpotomy. Following this procedure, a specific medication is typically applied to the entire stump to fix, mummify, or encourage repair of the residual radicular pulp.[1,2] In the primary teeth, formocresol has long been a well-liked pulpotomy medication. Since formocresol is toxic and has the ability to cause cancer, there have been questions about its use in humans.[3] Even with these issues, pulpotomy with Formocresol is still the method of choice. According to a survey done in the US, the majority of dentists used FC as a pulpotomy medication and were not worried about any side effects, but a survey done in the UK found that while 66.5% of paediatric dentists used FC for pulpotomies, 54.2% of them were worried about their preferred medication and were thinking about changing their technique. Due to the problems with formocresol, a number of substitute medications have been researched.[4]
Don M. Ranly classified pulpotomy based on treatment objectives into devitalization, (Mummification, Cauterization), preservation (minimal devitalization, noninductive) and regeneration (inductive, reparative). Non chemical methods of pulpotomy include use of electro surgery and lasers.5 (Table 1)
Various Pulpotomy Agents
Formocresol
Formocresol was introduced in 1904 by Buckley for the treatment of the putrescent pulp in animal teeth. Buckley’s original formula consisted of concentrated formalin 53 gm, cresol 35 gm, glycerol 7 gm and water 5 gm. A commercial formula was later introduced by Buckley that consisted of 19% formaldehyde, 35% cresol and glycerin in distilled water. A diluent consisting of 3 parts of glycerine (90 ml) added to 1 part distilled water (30 ml) is prepared. Later 4 parts of diluent (120 ml) is mixed with 1 part of Buckley’s FC (30 ml). Commercially available products vary in concentrations of their ingredients, for example Sultan formocresol available in India consists of 48.5% formaldehyde, 48.5% cresol and 3% glycerine. Formocresol prevents tissue autolysis by binding to peptide group of side chain of amino acid. It is a reversible process without changing of basic structure of protein molecules.[7,8]
Glutaraldehyde
It has been suggested that glutaraldehyde be used instead of formocresol during pulpotomy procedures on baby molars. Since glutaraldehyde is an active fixative agent that cross-links proteins thanks to its two active sites, Gravenmade suggested that it could be used as a new pulp fixative. It offered the advantages of formocresol without producing the less desirable side effects.9,10 Additionally, glutaraldehyde has shown to have better tissue fixation with minimal immunogenicity and minimal tissue diffusion.[11,12]
Calcium Hydroxide:
Herman first proposed calcium hydroxide as Calxyl in 1930. This substance was sought after for pulpotomy as well as pulp capping. Internal resorption in deciduous molars is frequently brought on by calcium hydroxide pulpotomy.[13,14] Compared to permanent teeth, the success rate of calcium hydroxide pulpotomy in primary teeth is lower. However, for direct pulp capping (DPC) and pulpotomy methods in permanent teeth, calcium hydroxide is the preferred material. (Mc Donald 1996).[15]
Ferric Sulphate (FS)
Recent interest in ferric sulphate, a non-aldehyde substance, as a pulpotomy agent. The idea behind this haemostatic substance was that it reduces the risk of internal resorption and inflammation by preventing the issue with clot development. Numerous studies have been done on 15.5% FS.[16] After 3 years of treatment, RCT-treated molars showed significantly higher survival than FS-treated molars, according to Casas et al. who used 16% FS in comparison to primary teeth pulpectomy. When ferric sulphate interacts with pulp tissue, ferric ionprotein complex is created, which physically closes capillaries at the site of an amputation and creates a barrier against sub-base irritants.[17]
Recent Pulpotomy Medicaments
Mineral trioxide Aggregate:
MTA, a bioactive material developed from Portland cement, was first introduced by Dr. Mahmoud Torabinejad at Loma Linda University in 1993 and its first reported use was by Lee et al. in 1993. Eidelman et al. (2001) evaluated the effectiveness of MTA as a pulpotomy agent in primary molars and reported a 100% success rate in 17-month follow-up.[18]
Biodentine
In 2009, biodentine (septodont), which was created specifically as a "dentine replacement" material, became widely available.[17] Biodentine has a high success rate when used as a pulpotomy medication, according to numerous studies, making it a positive and promising alternative to the existing pulpotomy medications.[20] At 6 and 12 months after biodentine pulpotomies in deciduous molars with physiologic root resorption, Nasseh et al. analysed the results and discovered 100% clinical and radiographic success rates.[21]
Chlorhexidine:
A common and effective disinfectant for eliminating a variety of oral bacteria is chlorhexidine. Following vital pulp treatment, chlorhexidine is electrospun into a polymer scaffold and applied as a pulp dressing. The chlorhexidine-loaded scaffold is made using a polyvinyl alcohol polymer with a molecular weight of 124,000 g/mol, 2% chlorhexidine gluconate, and purified water.[22]
Lyophilized freeze-dried platelet
The effectiveness of lyophilized freeze-dried platelet-derived preparation and calcium hydroxide in treating primary molars was examined by Kalaskar and Damle in 2004. After a 6-month follow-up, they discovered that lyophilized freeze-dried platelet was more effective than calcium hydroxide.
Theracal LC
Theracal light-cured, a tricalcium silicate modified with a light-curable resin, was developed in 2011 by Bisco Inc., Schamburg, Chicago, IL, USA.24 Theracal demonstrated considerably greater calcium releasing ability and lower solubility than either MTA or calcium hydroxide when its chemical and physical properties were compared to those of MTA and calcium hydroxide.[25]
PRP gel
Platelet-rich plasma gel is a blood-derived autologous modification of fibrin glue used to distribute growth factors in substantial amounts [70]. The fibrin clot that forms as a result of the autologous concentration of human platelets in a small volume of plasma, which replicates the coagulation cascade, solidifies and adheres to the application site. Its biocompatible and biodegradable qualities support healing by preventing tissue necrosis and widespread fibrosis. PRP has been shown to remain sterile and the concentrated platelets viable for up to 8 hours once developed in the anticoagulant state.[26] PRP was found to be an ideal material for pulpotomy with low toxic effect, increased tissue regenerating properties and good clinical results.[27]
Nano Hydroxy Apatite:
In medicine and dentistry, interest in Nano Hydroxy Apatite, which has been developed for augmentation treatments in osseous defects, is growing. NHA is non-irritating to pulp tissue and nontoxic. Following histological analysis, Shayegan et al. found that there was a notable difference between NHA and FC in terms of pulp response. According to the study's findings, NHA seems to be more biocompatible and causes pulp tissue to only mildly inflame in both pulpotomy and direct pulp capping therapies.[28]
Herbal Pulpotomy Medicaments
Natural products claimed to play a vital role and appear to be a viable replacement to formocresol. Although these natural products are being projected for their advantages and having a wide scope; there is lack of higher level of evidence to support its usage in dentistry.
Turmeric Powder
The perennial plant curcuma longa is widely grown in tropical nations like China, India, and others. Due to its antioxidant, anti-inflammatory, and antimicrobial properties, it has many pharmacological uses.[29] Due to its flavour and color, it is frequently used in cuisine. For the therapy of flatulence, menstrual issues, jaundice, hemorrhage, hematuria, and colic illnesses, it is widely used in Ayurvedic medical systems.[30,31] It has specialised properties that specifically inhibit cyclooxygenase 2 and lipoxygenase, acting as a strong anti-inflammatory agent. Turmeric is a natural anti-inflammatory and antioxidant which is widely used as an ayurvedic medicine. Purohit et al. in their study found a good clinical and radiographic success with turmeric powder in 6-month follow-up.[30]
Aloe Vera: Aloe vera, an African native, is also referred to as a "medicinal plant." It possesses many different qualities, including immunomodulatory, antiviral, anti-inflammatory, antibacterial, antifungal, and protective characteristics against a wide variety of microorganisms.[32] It also demonstrates outstanding antioxidant properties. Additionally, it has been linked to the management of cutaneous burns and wound healing. There are 75 possibly active components in it, including vitamins, enzymes, minerals, sugars, anthraquinones, fatty acids, hormones, and other beneficial compounds.[33] In dental, it serves as a healing agent for aphthous ulcers, extraction sockets, and persistent oral lesions, in addition to being used to treat lichen planus. Gupta et al. examined the effects of freshly extracted A. vera gel from its leaves as a pulpotomy agent in primary molar teeth due to these properties, and A. vera was used as a pulpotomy agent. All pulpotomized teeth were examined clinically, radiographically, and histopathologically for roughly one month. They came to the conclusion that newly extracted A. vera gel can function effectively as a pulpotomy agent.[34]
Conclusion
It's crucial to correctly investigate, diagnose, and choose the medication for the pulpotomy technique. Despite having a number of disadvantages, FC is still one of the most widely used pulpotomy drugs. Alternative medications have been researched and used; each has its own benefits and drawbacks. Several medications, including MTA and natural products, declare to be a competitive option to FC.
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