Materials Used in Pediatric Endodontics

7/22/2019 Materials Used in Pediatric Endodontics

1/122

1

Guided By:Dr. Binita Srivastava

Dr. Archana AggarwalDr. Nidhi GuptaDr. Rashi SinghDr. Neeti

Presented By:Dr. Parul Verma

Final yr PG Student


2/122

1. Introduction

2. History

3. Pulp Capping Agents- Calcium Hydroxide

Isobutyl Cyanoacrylate

Corticosteroids and antibiotics

Collagen fibers

4-Meta adhesive

Direct bondingDenatured albumin

Mineral trioxide aggregate(MTA)

Laser

BMP 2

CONTENTS:


3/122

4. Pulpotomy Agents- Formocresol Glutaraldehyde

Calcium hydroxide

ZnO eugenol

Ferric Sulphate

Bone Morphogenic proteins & Osteogenic proteins

Devitalizing paraformaldehyde paste

Beechwood creosote

Antibiotic paste

Enriched collagen solution

Collagen calcium phosphate gel

Dimethyl suberidement

Tetrandrine

Freeze Dried bone Tricalcium phosphate

Chondroitin sulphate

Denatured albumin

Sodium hyaluronate

3


4/122

5. Properties of an ideal root canal filling material

6. Pulpectomy Agents- Zinc oxide eugenolIodoform pastes- KRI , Walkhoff, Maisto

Endoflas

Calcium hydroxideVitapex

4


5/122

INTRODUCTION

Primary objective of Pulp treatment of an affected tooth is to

maintain the integrity & health of oral tissue.

AAPD 1991, it is possible to stabilize pulp autolysis or

eliminate the pulp entirely without significantly compromising

the function of the tooth.

Aimto treat reversible pulpal injures in both primary &

permanent teeth, maintaining pulp vitality & function.

5


6/122

HISTORY

6


7/122

1700S & Early 1800sMetal Foils

Mid 1800s to Early 1900sAsbestos fibers, cork,

beewax, pulverized glass, Calcium compounds &

other based on Eugenol

19th centuryhuman pulp had very little healing

power.

1874Nitzel : Tricresol- formalin tanning agent

7


8/122

1886Adolph WilzelMetal (Gold) Foil

1885LeptowskiFormalin

1898GysiParaformaldehyde

Triopaste

1904BuckleyFormocresol or Tricresol Formalin

1908Solid Formaldehyde

8


9/122

Boennecken40% Formalin, Thymol, Cocaine

1930HermannCalcium mixture Calxyl

1938Zender & TeuscherCalcium Hydroxide

1955Teuscher & Nybrong

1975S Gravenmade - Gluteraldehyde

9


10/122

1978Ranly & LazzariGulteraldehyde (Pulpotomy agent)

1979Wright & MidmerFormocresol causes chronicinflammation

1983Reumping et al - Electrosurgery for Pulpotomy

1985Shoji et alCarbon dioxide laser in pulpotomy

1991NakashimaBone Morphogenic Proteins

1993Rutherford et alOsteogenic Proteins

10


11/122

11

INDIRECT PULP CAPPING:

It is defined as the application of amedicament over a thin layer of remaining

carious dentin, after deep excavation, with no

exposure of the pulp.

The treatment objective is to avoid pulp

exposure by stimulating the pulp to generate

reparative dentin beneath the carious lesion.


12/122

12

This results in the arrest of caries

progression and preservation of the vitality ofnon exposed pulp.

Next sitting involves re-entry after a 6 to 8-

week interval to remove any remaining carious

dentin and place the final restoration.


13/122

13

A) Medicament is placed against remaining caries.

B) Lasting temporary restoration.

Following repair, both materials are removed along with softenedcaries, and final restorations are placed.

Ingle; Pediatric Endodontics


14/122

14

DIRECT PULP CAPPING:

Direct pulp capping involves the placement of abiocompatible agent on healthy pulp tissue that

has been inadvertently exposed from caries

excavation or traumatic injury. The treatment objective is to seal the pulp

against bacterial leakage, encourage the pulp to

wall off the exposure site by initiating a dentinbridge, and maintain the vitality of the

underlying pulp tissue regions.


15/122

15

A) Capping material covers pulp exposure and the floor of the cavity.

B) Protective base

C) Restoration.


16/122

16

PULP CAPPING AGENTS:

1. Zinc Oxide Eugenol- Before calcium hydroxide

came into common use, zinc-oxide eugenol was

used more often than any other pulp capping

agent.

2. Calcium Hydroxide- Herman (1930) introduced

calcium hydroxide for pulp capping. In 1938,

Teuscher and Zander introduced calcium

hydroxide in the united states.


17/122

17

When calcium hydroxide is applied directly to

pulp tissue reparative dentin bridge formation

occurs at the junction of necrotic tissue and

vital inflamed tissue.


18/122

18

Three main calcium hydroxide products are:

Pulpdent Paste contains 52.5% calcium

hydroxide in an aqueous methyl cellulose solution.Considered to be most capable of stimulating

early bridge formation.

Hydrex- It is a two paste system, non-essential oil hard setting compound that contains

calcium hydroxide, barium sulfate, titanium

dioxide and a selected resin.

Dycal


19/122

19

3. Isobutyl Cyanoacrylate- Introduced by

Berkman in 1971. It has been reported to be an

excellent pulp capping agent because of its

hemostatic and bacteriostatic properties.

It cannot be regarded as an adequate

therapeutic alternative to calcium hydroxide

since it does not produce a continuous barrier of

reparative dentin after application to the

exposed pulp


20/122

4. Corticosteroids and antibiotics- Introduced by

Brosch JW in 1966. These agents include neomycin and

hydrocortisone, ledermix (calcium hydroxide and

prednisolone), penicillin or vancomycin with calcium

hydroxide.

5. Collagen Fibers- Influences mineralization and are

less irritant than calcium hydroxide with dentin bridge

formation in 8 weeks.

6. 4-META adhesive- It can soak into the pulp,

polymerize there and form a hybrid layer with the pulp

providing adequate sealing. 20


21/122

7. Direct Bonding- A polygenic film can be layered over

an exposed site without displacing pulp tissue and onto

surrounding dentin where it penetrates the tubules. The

film acts as a barrier as composite resin is gently

spread over the pulp onto the surrounding dentin.

8. Denatured Albumin- This protein has calcium binding

properties. If applied over the exposed pulp it becomes

a matrix for calcification.

9. Laser- Introduced by Andreas Meritz in 1998. He

evaluated the effect of laser on DPC and reported a

success rate of 89%. 21


22/122

10. Mineral Trioxide Aggregate (MTA)- Torabinejad

described the physical and chemical properties of MTA

in 1995. It is ash colored powder made up of fine

hydrophilic particles of tricalcium aluminate, tricalcium

silicate, silicate oxide, tricalcium oxide and bismuth

oxide.

Properties:

1. Biocompatible and sealing ability better than that of

amalgam and ZOE.

2. Initial ph is 10.2 and set ph is 12.5

3. Setting time of cement is 4 hours. 22


23/122

4. Compressive strength is 70 MPA, which is comparable

with that of IRM.

5. Presents minimal inflammation if extended beyond

the apex.

Mechanism of action:

1. Forms CH that releases calcium ions for cell

attachment and proliferation.

2. Creates an antibacterial environment by its alkaline

pH.

3. Encourages differentiation and migration of hard

tissue-producing cells 23


24/122

4. Forms hydroxyapatite on the MTA surface and

provides a biologic seal.11. Bone morphogenic protein- Discovered by Urist in

1965. It has inductive properties and forms both bone

and dentin.

24


25/122

PULPOTOMY

25


26/122

Pulpotomy is defined as amputation of vital pulp from the coronalchamber followed by placement of a medicament over the

radicular pulp stumps to stimulate repair, fixation or mummificationof the remaining vital radicular pulp. (Braham & Morris 1985)

Removalofthe coronal portion of the pulp & the treatment of the

remaining radicular pulp in an attempt to maintain the tooth & its

supporting structure in a state of health. (Heillig 1984)

Procedures involving removal of vital, partially inflamed coronalpulp tissue & placing a dressing over the amputed pulp stumps &

placing the final restoration. (Kennedy 1986)

26


27/122

Procedure in which the entire coronal pulp is removed, with the

aim of removing all the infected pulp tissue, the radicular pulp is

then treated in different ways, according to technique employed.

(Andlaw & Rock 1993)

Complete removal of the coronal portion of dental pulp, followed

by placement of a suitable dressing or medicament that will

promote healing & preserve the vitality of the tooth. (Finn)

27


28/122

MEDICAMENTS

28


29/122

29

Formocresol

Glutaraldehyde

Calcium hydroxide

ZnO eugenol

Ferric Sulphate

Bone Morphogenic proteins & Osteogenic proteins

Devitalizing paraformaldehyde paste

Beechwood creosote

Antibiotic paste

Enriched collagen solution

Collagen calcium phosphate gel

Tetrandrine

Freeze Dried bone

Tricalcium phosphate

Chondroitin sulphate

Denatured albumin

Sodium hyaluronate


30/122

Action of Formocresol on pulp tissue: Formaldehyde undoubtedly fixes the pulp tissue

Alters blood flow by inducing thrombus formation

ischemia causes coagulation necrosis of tissue deprived ofits normal nutrition.

Enzymatic hydrolysis of necrotic tissues replacement of it

by granulation tissue.

Slight resorption of dentinal walls in zone of replacement &

deposition of osteodentin as a repair tissue.

30

FORMOCRESOL Introduced by Buckleys 1904


31/122

31


32/122

Buckleys FormocresolFormalin (37%) : 19%

Tricresol : 35%Glycerin : 15%

Water

Achieve 1:5 concentration of original Buckleys formocresolDilute 3 parts glycerine with 1 part of distilled sterile water.

Add 1 part formocresol to 4 part diluent

90ml glycerine

30ml water Loos et al

30ml formocresol

32


33/122

Emmerson : determined significant formocresol action

within 1st five minutes.

Braham & Morris : Linear calcification may have adverseinfluence on resorption process.

Histological Observation:

Massler M & Mansukhani N : surface of pulp

immediately under formocresol became fibrous & acidophilic

within few minutes after application of formocresol.

33


34/122

3 distinct Zones:

Acidophilic zone of fixation

Zone of atrophy

Zone of inflammatory cells

No reparative dentin formation.

Berger - histologic findings:

3 weeks postoperative:

1. Nuclei, cytoplasm & intercellular ground substancemost

Coronal region, all dark stain

2. Odontoblast & other cellular elements well outlined &

distended blood vessels with well preserved erythrocytes

34


35/122

Middle 3rd:

1. Stain of tissue decreased

2. Cellular details less distinct

Apical 3rd:

1. Absence of cellular details

2. Blood vessels containing decomposed erythrocytes which

appeared to lose structural integrity

7weeks post operative:

1. Dark stained coronal zone, light stained middle zone & Cellular

apical zone

2. CT originating from periodontal ligament

3. Richly vascular & contained lymphocytes, PMN, macrophages,

proliferating fibroblasts & granulation tissue

35


36/122

Connective tissue undergoing castration due to decreased

number of mature fibroblasts & increase of fibrous

intracellular elements.

Coagulation necrosis in middle 3rd, delineated apically by a

zone of necrotic tissue

Braham & Morris - these zones are obvious in1 month &

established in 3months although pulpal fixation did not extend to

the apex

36

T i it


37/122

Toxicity Post operative systemic transport

Possible effects on the enamel of succedaneous teeth

Reversible fixation leading to autoantibody formation

Mutagenicity & Carcinogenicity

Destruction of cellular integrity due to cresol factor

Irreversible connective tissue changes

Irritation & necrosis

Leukoplakia & lesions resembling carcinoma in situ

37


38/122

Local Toxicity

PruhsAll permanent teeth showed enamel defectsbecause:

Formocresol which damages the permanent tooth germs

Inflammation which was in the primary tooth which causes

the defects in the permanent tooth germs.

38


39/122

39

Human studies not done.

Kettley & Mejare in animals

Formaldehyde labeled with radioactive carbon which was

apparently distributed among the muscles, liver, kidney, heart,spleen & lungs. 1% of total administered dose was absorbed.

Myers et al & Pashley et al concluded that 5-10%

formaldehyde is absorbed systemically from pulpotomy

sites.


40/122

Mutagenicity & Carcinogenicity

Most common type of DNA damageClastogenic lesions,

micronuclei & chromosomal aberration & deletions.

Ribeiro et al not produce detectable DNA damage & not

considered genotoxic.

40


41/122

Advantages Commonly available medicament

Stable at room temperature Long shelf life

Disadvantages: Reaction reversible

Very caustic medication

High dose toxic

Systemic absorption & distribution throughout the body

Has mutagenic & cariogenic potential

41


42/122

Internal resorption of the root adjacent to the area where the

formocresol was applied.

Radiolucency may develop in the bifurcation or trifurcationarea.

Furcal lesions may contain granulomatous tissue having the

potential for cyst formation.

42

Area showing root resorption following formocresol pulpotomy.


43/122

43

GLUTERALDEHYDE

Known for its high degree of cross linking & limited

diffusability.

By S Gravenmade

Denkertminimum diffusion through apices.

Martin J. Davis, Myers & M.D.Switkes- more active in

fixing surface tissue & more rapidly limited depth ofpenetration through tissues.


44/122

44

Martin J. Davis et al : Glutaraldehyde & Formocresol - does not

perfuse through the apex & shows no systemic distribution & other

extra dental phenomena.

Franklin Gracia Godoy et al : ZnO as vehicle for Glutaraldehyde

2% glutaraldehyde incorporated in ZnO not effective as when

applied for 5min.

Hue- Wen- Jeng et al : compared cytotoxicity & found human pulp

fibroblastformaldehyde is more toxic & 2.5% glutaraldehyde is

15-20times less toxic

Hermandez Pereyra et al : 2% glutaraldehyde & FormocresolR/G

success of 80% & 90% with glutaraldehyde after 6months & 2yrs.


45/122

45

Prakash C. et al : formocresol showed 90% success whereas

Glutaraldehyde 100% success. Glutaraldehyde better fixative & less

toxic.

Histology


46/122

46

Histology

Martin J. Davis, Myers & Switkase -5% buffered

glutaraldehyde, pH= 8.5After 1week:

Coronal third: radicular tissue fixed & found to be non vital. Cells

compressed & darkly stained

Middle 1/3rd: radicular tissue vital with good cellular details & moderate

inflammation

Apical 3rd: vital with scattered inflammatory cells.

After 4 weeks:

Coronal 3rd: same

Middle portion: clear cellular details, unchanged degree of inflammation.

Limited dystrophic calcification apparent on lateral wall of canal.

Apical 3rd: apparently vital with occasionally observed inflammatory cells.

Aft 8 k


47/122

47

After 8weeks:

Coronal 3rdno change

Middle 3rd: dystrophic calcification apparent

Apical 3rd: vital & demonstrated good cellular details with scattered inflammatory

cells.

Appearance of multinucleated giant cells & fibroblasts. Indicative of replacement

repair

Deep red cellular zone adjacent to amputation surface & few lymphocytes &

plasma cells. Blood vessels dilated. Remaining pulp free of inflammatory cells &

root canal lined with layer of reparative dentin.

After 3months:

Coronal region: stained redPulp tissue: no layering or signs of inflammation. Macrophages visible in &

adjacent to red zone.

No pathosis noted.


48/122

48

Kopel concluded:

2% glutaraldehyde accepted as dressing medicament for maintaining

vitality of remaining pulp.

Histologically, pulp tissue in root does not resemble pulp tissue subjectedto formocresol

Initial zone of fixation adjacent to dressing does not proceed apically.

The tissue which adjoins fixed zone has cellular details & is vital.

Fixed zone replaced through macrophagic action with dense collagenoustissue.

Established biochemical properties & effect on vital pulpuse of 2%

glutaraldehyde as pulpotomy agent.

Anna B. Fuks - contraindicate use of Glutaraldehyde

Kopel & Gracia Godoyrecommend use of 2% Gluteraldehyde for 1 or

3min


49/122

49

Advantages:

Reaction with pulp irrevisible Molecules do not diffuse out of apical foramen

Fixes tissue instantly

Not known to be cytotoxic, mutagenic & cariogenic

No systemic toxic effect.

Disadvantages:

Short shelf life

Freshly prepared

Buffered solution to be refrigerated.

Glutaraldehyde Vs Formocresol


50/122

50

Glutaraldehyde Vs Formocresol

Advantages of Glutaraldehyde over Formocresol:

Is better bactericidal

Not diffuse apically or laterally from the canals Not known to be cariogenic

Not induce toxic effect

Less systemic distribution immediately after application

Fixes tissue instantly

Not known to be caustic

Better fixation at lower conc.


51/122

51

FERRIC SULFATE

15.5% solutionFei et al 1991

Used: coagulative & haemostatic retraction agent for crown & bridgeimpression & slightly acidic

MOA- agglutination of blood proteins results from reaction of blood with

both ferric & sulfate ions.

Schroedercontrolling hemorrhage might minimize chance ofinflammation & internal resorption clot formation.

Ranlymetal protein clot may act as barrier to irritative components ofsub-base & function in passive manner.

Landaw & Johnson - 1st to study pulpal response from ferric sulfate inmonkey teeth.

Ferric Sulfate Vs Formocresol


52/122

52

Ferric Sulfate Vs FormocresolAuthor C/L & R/G

success respc. of

formocresol

C/L & R/G

success respc. of

ferric Sulfate

Duration

Fei et al 1991 96% & 91% 100% & 97% 12mths

Fuks et al 1997 84% & 80% 93% & 93% 34mths

Aktoren & Gencay2000

88% & 80% 88% & 84% After 24mths

Papagiannoulis

2002

97% & 78% 90% & 74%

Ibrevic & Al Jame

2003

96% & 92% 42mths

Huth et al 2005 96% & 90% 100% & 86% 24mths

Morkovic et al

2005

89% & 82% 18mths

ZINC OXIDE EUGENOL (ZOE)


53/122

53

ZINC OXIDE EUGENOL (ZOE)

Considered as therapeutic or obtundent.

Used as non toxicve control but, applied directly todental pulp, nerve tissue , this medicamenttoxic

Flagg 1875clove oil + zinc oxide plastic mass

Used as: base, temporary dressing, endodontic root

filling paste, impression material, PD packs & asPulpotomy medicament.

Composition


54/122

54

Composition

Various formulations & uses of ZOE restorative material:

Type 1: temporary cementation

Type 2: permanent cementation of restoration

Type 3: temporary filling material, thermal insulating

base

Type 4: cavity liners

Composition:

Powder Liquid

Zinc oxide: 69%

White resin: 29.3%

Zinc sterate : 1%

Zinc acetate: 0.7%

Eugenol: 85%

Olive oil: 15%

Histology


55/122

55

HistologyJames E. Berger : active inflammatory reactions which varied

from simple chronic to acute suppurative pulpitis.

Boller RJ : calcific deposition associated with dentinal debris &

bridge formation.

R.L. Glass & H.A. Zander: inflammation, abscess formation &liquefaction necrosis.

24hrs after:

underlying tissue contain mass of red blood cells & PMN leukocytes

Hemorrhage mass demarcated by Zone of fibrin & inflammatory cells

2weeks after:

Degeneration of pulp & chronic inflammation extends into apicalportion of pulp lymphocytes, plasma cells & PMNs leukocytes

Failed to stimulate osteogenesis.

6 months: 1 tooth showed acute inflammation involving entire


56/122

56

6 months: 1 toothshowed acute inflammation involving entire

pulp

12 months: microscopic appearance of acute inflammation

18months: all teeth showed chronically inflamed pulp & absenceof fibrous tissue.

Doyle et al 92%histologic success, 92% R/G & 100% clinical

Success.

Ranly : lowclinical success rate (80 to 82%)


57/122

57

Zinc Oxide preparationsVarious preparations used as pulpotomy medicament:

Zinc oxide/Eugenol & Paraformaldehyde

Zinc oxide/Liquid Paraffin & Paraformaldehyde

Zinc oxide/ Liquid paraffin


58/122

58

CALCIUM HYDROXIDE

Foreman & Barnes

Hermann & Zander - introduced for Pulpotomy & foundsuccess rate of 70%

Granath :Apexification following trauma

Kaiser & Frank : use for apexification

Pure form- high pH & dental use ability to stimulate

mineralization & antibacterial properties.


59/122

MECHANISM OF ACTION:

Antimicrobial activity of calcium hydroxide isrelated to the release of hydroxyl ions in aqueous

environment.

Hydroxyl ions are highly oxidant, free radicals

that show extreme reactivity.

Their lethal effects on the bacterial cells are

probably due to the following mechanisms:

59


60/122

Damage to the bacterial cytoplasmic

membrane:

Hydroxyl ions induce lipid oxidation destruction

of phospholipids.

Hydroxyl ions generates free lipid radical.

This free radical reacts with oxygen formation ofa lipidic peroxidase radical.

Thus, peroxidases act as free radicals resulting in

extensive tissue damage.

60


61/122

Proteindenaturation:

The alkalinization provided by calcium hydroxide

breakdown of the ionic bonds that maintain the

tertiary structures of proteins.

Loss of biological activity of the enzyme anddisruption of the cellular metabolism.

Structure may also be damaged by hydroxyl ions.

61


62/122

Damage to the DNA:

Hydroxyl ions react with the bacterial DNA and

induce the splitting of the strands.

Genes are then lost. Consequently DNA

replication is inhibited and the cellular activity is

disarranged.

62

Composition & Chemistry


63/122

63

Composition & Chemistry

De Freitas & Rosser : cements set by acid base reaction, the

phenolic group in alkyl salicylate ester acting as acid.Once set, therapeutic activity depends upon release of calcium &

hydroxyl ion which occur if cement water soluble.

Plasticizer imparts solubility.

Milosevic - calcium hydroxide reaction with salicylate ester

chelating agent in presence of toloudine sulphonamide plasticizer.

Hydrophilic & Soluble.

Ca hydroxide powder + distilled water creamy paste with high


64/122

64

Ca hydroxide powder + distilled water creamy paste with high

alkalinity

3 main products:

Pulpdent- 52.5% calcium hydroxide suspended in aqueousmethyl cellulose solution

Dycalby L.D. Caulk.

Available in 2 pastes- Base & Catalyst

Base: Titanium dioxide in glycol salicylate

Catalyst: Calcium hydroxide & ZnO in ethyl toluene sulfonamide.

Hydrex: 2 paste; non essential oilcontain calcium hydroxide,

barium sulphate, titanium dioxide & selected resin.

Hydrex- hydrophobic paraffin oil methacrylate.


65/122

65

Hydrex hydrophobic paraffin oil methacrylate.

1. Relatively insoluble (Prosser )

2. Poor antibacterial properties (Fisher & Mc Cabe ; Fisher &Shortal )

3. Hydroxyline resistant to acid etching (Milosevic)

4. Linn & Mc Cabe reaction between calcium & Zn ions & a

salicylate chelating agent is accelerated by presence of

water.

Histology


66/122

66

HistologyTeuscher & Zander -

Superficial layernecrotized, accompanied by acute inflammatory

changes. Demarcated by new, deeply staining zone comprisingbasophilic elements of Ca Hydroxide dressing

Proteinate zone present

New area of fibrous tissue linked to primitive type of bone.

After 4weeks:

Acute inflammation subsides new odontoblastic layer bridge of

dentin

Pulp tissue beneath calcific bridgevital & free of inflammatory cells.

Calcium hydroxide appears to stimulate resorption.

Andersen External root resorption of avulsed teeth when


67/122

67

p

repositioned with cal hydroxide

Law 49% success in 1yr

Doyle et alhistological success of 50% & R/G 64% & clinicalsuccess 71%

Schroder67% clinical success after 1yr; 38-59% after 2yr in 33

pulpotomized primary teeth.

Hellig et al rapid decrease in hemorrhage & better R/G.

Internal Resorption:

Occurs near junction of coronal & radicular pulp (Hannah & Rowe )

Inflammation- inflammatory cells attract osteoclastic cells &

initiate internal resorption

Vascularity of apical region increased

Osteoclastic activity predispose to External Resorption when an

irritant (CaOH)2 is placed on the pulp.

Via69% failure (internal resorption)

L 54% f il


68/122

68

Law54% failure

Magunsson80% failure

Comparing CALCIUM HYDROXIDE with FORMOCRESOL:

Author Clinical & R/Gsuccess of Ca

hydroxide

Clinical & R/Gsuccess of

Formocresol

Duration

Waterhouse et al 77% 84% 22mths

Huth et al 87% 96% 24mths

Markovic et al 82% & 76% 91% & 85% 18mths

BONE MORPHOGENIC PROTEINS


69/122

69

BONE MORPHOGENIC PROTEINS

& OSTEOGENIC PROTEINS

Proteins evaluated from osteogenic potential

Pulp responsesdetermined in dogs & primary teeth

Role in healing bone & pulp

BMP 4epithelial/ mesenchymal interaction during early

tooth development (Ranly DM)

BMP Function


70/122

70

BMP 1 It is a metalloprotease that acts on procollagen I,II,III. Involved

in cartilage development

BMP 2 Acts as a disulfide linked homodimer & induce bone & cartilage

formation. Plays role in osteoblast differentiation.

BMP 3 Induce bone formation

BMP 4 Regulates the formation of teeth, limbs & bone from mesoderm.

Role in fracture repair also

BMP 5 Function in cartilage development

BMP 6 Role in joint integrity in adults

BMP 7 Key role in Osteoblast differentiation. Role in renal development

BMP 8a Involved in bone & cartilage development

BMP 8b Expressed in hippocampus

BMP 10 Role in trabeculation of embryonic heart

BMP 12 Potential repair of alveolar bone defects

BMP 15 Role in oocyte & follicular development

FREEZE DRIED BONE


71/122

71

FREEZE DRIED BONE Used in Orthopedic & Oral surgery.

Pulp & dentinMesodermal tissuesFreeze dried boneserve as inducer of calcific barrier at amputation site.

Mc Lean & Urist 1968

Interaction of mesodermal cells & mesodermal derivativesduring bone resorption that induce differenation.

Alternative for Formocresol

Fadavi et al 1996

COLLAGEN


72/122

72

COLLAGEN

Bimstein E, Shoshan S.Enriched Collagen Solution.

Anna B. Fuks, Y. Michaeli et al 80% teeth vital pulp &

73% of teeth dentin bridge present & cells proliferating

through incomplete dentin bridge.

Nevins et alused CollagenCalcium Phosphate gel

paste.

TETRANDRINE


73/122

73

TETRANDRINE

Noval Anti Inflammatory Agent.

Composition:

98% buffered saline dissolved in Phosphate &

20% 0.1N HCl with pH 7.2

Tetrandrine pulpotomies Showed significantly less

inflammatory changes as compared to formocresol.

FERACRYLUM


74/122

74

FERACRYLUM Incomplete iron salt of Polyacrylic acid0.05-0.5% iron

MOA: binds with plasma proteins & form clot

Properties:

Bacteriocidal property

Devoid of Systemic toxicity

Used for various medical surgeries

Neetu T. Prabhu & A.K. Munshi : clinical success 100%

Histological Examination after 1month: 4 zones-

Eosinophillic zone Zone of Ghost cells

Inflammatory zone

Normal radicular pulpal tissue

CALCIUM PHOSPHATE CEMENT


75/122

75

CALCIUM PHOSPHATE CEMENT

Clinical applicationOrthopedic & Dentistry

Composition:

Powdercalcium & Phosphorous ingredients

Liquidaqueous solution of phosphates

Cement undergoesthermal setting & gets

converted into hydroxyapatite.

TETRACALCIUM PHOSPHATE


76/122

76

TETRACALCIUM PHOSPHATE

CEMENT (4CP)

Calcium phosphate ceramics tricalcium phosphate

- bone substitute

tricalcium phosphate

- Dental cement

Yoshimine Y 1993: 4CP effective as bone cement.

Yoshimine Y 1995: 4CP as a Direct pulp capping agent. No finding of necrosis

Biocompatible

MINERAL TRIOXIDE AGGREGATE


77/122

77

MINERAL TRIOXIDE AGGREGATE

Lee & colleagues 1993 : 1st to get MTA

in dental literature.

Used : Root end filling, DPC, perforation repairs in root,furcation & apexification.

Ideal to use against bone.

Allow for overgrowth of cementum & formation of bone

& facilitate regeneration of PDL.

C iti Ph i l & Ch i l


78/122

Composition, Physical & ChemicalProperties

Mixture of refined Portland cement & bismuth oxide

Portland cement: Dicalcium silicate,Tricalcium silicate,

Tricalcium aluminate, gypsum & Tetrcalcium alumino ferrite.

Trace Elements: SiO2, CaO, MgO,

Gypsum : Setting time

Aluminum species: longer working time

Powder : Liquid3:1

78

Hydration: MTA forms Colloidal gel solidifies to hard tissue3 4h


79/122

79

3-4hrs.

Initial pH10.2 which rises to 12.5 three hrs after mixing.

Compressive Strength: increase in presence of moisture for upto21days.

Microhardness & hydration behavior adversely affected

Upto 2002 : GREY colored powder MTA.(GMTA)

WHITE MTA (WMTA) : Pro Root MTA (Dentsply Endo. Tulsa)

Mineralization:

Induce hard tissue formation in pulpal tissue

Histologic evaluation: stimulate Reparative dentin formation withthick dentinal bridging, minimal inflammation & normal hypermia.


80/122

80

WMTAfound to have 54.9% less Al2O3, 56.5% less MgO &

90.8% less FeO.

FeO cause color change

WMTA smaller particle size.

WMTA : is significantly less soluble, exhibit greater hardness

& more radiopaque.

MTA as Pulpotomy dressing


81/122

81

MTA as Pulpotomy dressing

Eidelman E : pulp obliteration seen at higher frequency in GMTA

Cuisia et al : 93% clinical &77% radiographic success with formocresol

& 97% Clinical & 93% radiographic success with MTA

Jabbarifar et al : 94% success with MTA

Agamy : GMTA>WMTA=Formocresol- 12mths

Farsi N : non failure with WMTA whereas 13% radiographic failure &2% clinical failure with formocresol- 24mths

Holan et al : 83% success- formocresol & 97% with MTA- 74mths

Nark & Hegde : 100% success with MTA in 6mths


82/122

82

Maroto M: GMTA 100% clinical success & 50% radiographic success

WMTAradiographically 69% pulp canal signs of stenosis

11.5% - dentin bridge & 1 canal exhibited early signs ofinternal resorption

No statistical significance in rate of stenosis, but GMTA showed significant

more dentine bridge.

Pinto LM : 2 failure with MTA & 6 failure with Calcium hydroxide in 12mths.

Barreshi Nusairk: after 24mths 79% - +ve results.

64% had hard tissue bridge formation while 7 teeth displayed R/G signs ofcontinued root development.

Chacko V : WMTA induced more homogenous & continued dentin bridge with

less pulpal inflammation than Calcium hydroxide.


83/122

83

Ideal Requirements of Root filling


84/122

84

q gMaterials-

The material should resorb as the primary tooth root

resorbs. Not irritate the periapical tissues nor coagulate any

organic remnants in the canal. Have a stable disinfecting power. Any surplus material passed beyond the apex should

be resorbed easily. Inserted easily into the root canal and also removed

easily if necessary. Not be soluble in water. Not discolor the tooth.

Radio opaque. Harmless to the adjacent tooth germ. Adhere to the walls of the canal & should not shrink Not set as a hard mass, which could deflect erupting

successor

(Catagnola 1952, Rifkin 1980, Woods 1984)

Zinc Oxide Eugenol ( ZOE)


85/122

85

Zinc Oxide Eugenol ( ZOE)

To fill root canals of primary teeth was first described bySweet 1930

Roths Sealer

Powder

Zinc oxide reagent- 42 parts

Stabelite resin 27 parts Bismuth subcarbonate 15 parts

Barium sulphate 15 parts

Sodium borate, anhydrous 1part

Liquid

Eugenol

Properties


86/122

86

Properties

Extended working time- but set faster in mouth due toincreased temperature & humidity.

Good sealing potential because of small volumetric changes on

setting

Eg Tubliseal, Wachs Cement, Nogenol


87/122

87

Gould

First proposed single visit pulpectomy

39 molars were filled with ZOE after a follow up of 16 months

35 out of 39 were successful.

E i & M b l


88/122

88

Erausquin & Muruzabal

Used ZOE in 141 rats followed from 1-90 days

ZOE irritated the periapical tissues and caused necrosis of

bone & cementum.

Extruded ZOE developed fibrous capsule that prevented

resorption

Coll


89/122

89

Coll

Retained ZOE after loss of pulpectomized tooth

27.3% after a mean of 40.2 months after loss of treated tooth

Retained

Short filled ( 1mm or more short of apex) retained ZOE less

often than beyond fills

Size of particles of most retained ZOE filler decreased over

time

Antibacterial Activity


90/122

90

Antibacterial Activity

ZOE could not inhibit Echerichia coli, S. aureus,

Streptococcus viridans

Inhibited- S.aureus & S.viridans

Inclusion of zinc acetate allowed to inhibit all three

Cox et al


91/122

91

Iodoform Pastes-

Rifkin 1980, 1982.


92/122

92

KRI

Walkhoff 1928Parachlorophenol, Camphor, Menthol Iodoform Paste

2.025%- Parachlorophenol

4.86%- Camphor

1.215%- Menthol 80.8%- Iodoform

Rifkin - It meets all criteria required from an ideal root canalfilling material

Advantages


93/122

93

Advantages

Disinfectant to treat osteitis after extractions Remains in paste form and never sets to a hard mass.

Smooth, viscous material, can be spun in with lentulo-spiral orinjected with pressure syringe

Resorbable so if inadvertantly expressed into periapical

granulomatous tissue is rapidly removed and replaced byhealthy connective tissue ( Castagnola , Woods )

Resorbs in synchrony with roots.

Easily inserted and removed

Resorbs from apical tissues in one or two weeks.

Holan Anna Fuks -


94/122

94

Holan Anna Fuks

Compared the ZOE and KRI

Success rate of both was similar if underfilled

Slightly higher when KRI flushed to the apex

Maistos Paste


95/122

95

Maisto s Paste

Maisto 1967

Zinc oxide- 14g

Iodoform42g

Thymol- 2g

Chlorphenol camphor-3cc

Lanolin- 0.50g

Eliyahu Mass


96/122

96

y

Maisto was successful in treating infected molars.

Iodoform containing pastes are easily resorbed from the

periradicular region.

These cause no foreign body reaction like Zinc Oxide Eugenol

Over filling and resorption of iodoform containing had no

effect on success of treatment rather had positive healing

effect.

Reddy VV, Fernandes .
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Reddy%20VV%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Fernandes%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Fernandes%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Reddy%20VV%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


97/122

97

Reddy VV, Fernandes .

On clinical evaluation, teeth obturated with Maisto's paste

showed 100% success. Five teeth that were overfilled with Maisto's paste showedcomplete resorption of excess material within 3 months

while the two teeth overfilled with zinc oxide-eugenol showedincomplete resorption of the excess material even after 9

months. Zinc oxide-eugenol treated cases showed only 26.7% bone

regeneration while in case of Maisto's paste, it was 93%.

Complete healing of the inter-radicular pathology was seenwith Maisto's paste.

However, the pathology was present in 40% of the zinc oxide-eugenol treated teeth even after 9 months.

Maisto's paste was thus seen to be superior to zinc oxide-eugenol.

Endoflas
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Reddy%20VV%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Fernandes%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Fernandes%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Reddy%20VV%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


98/122

98

Endoflas

Resorbable paste produced in South America Similar to Vitapex contains Zinc oxide and eugenol

Paste-

Tri-iodomethane , Iodine dibutilorthocresol- 40.6%

Zinc oxide- 56.5% Calcium Hydroxide1.07%

Barium sulfate 1.63%

Liquid-

Eugenol Paramonochlorophenol


99/122

99

Hydrophilic material- can be used in humid canals

Firmly adheres to the surface to provide good seal

Disinfects dentinal tubules & hard to reach accessory canals

Broad spectrum antibacterial effect

It resorbs when extruded extra radicularly but does not wash


100/122

100

It resorbs when extruded extra-radicularly but does not wash

out intra-radicularly.

( Fuks) Eugenol causes periapical irritation ( Erausquin)

Calcium Hydroxide


101/122

101

Calcium Hydroxide

Antiseptic

Osteoinductive properties(Hendry , Stevens 1983, Sjogren ).

Gets depleted from the canals earlier than the physiological

resorption.( Pitts )

Lentulo spiral has been reported to be the most effective in

carrying calcium hydroxide paste to working length- highest

quality filling.


102/122

102

Resorbs within 1-2 weeks when extruded(Ranly)

Causes no damage to permanent tooth (Reyes)

Can be removed easily

Eg. Sealapex.- 92.3% success (Sari )


103/122

103

Rehman

Determined the amount of duration of diffusion of calcium ionfrom both calcium hydroxide containing root canal sealer and

an intracanal medicament

Calcium ion diffusion was more in non setting group.


104/122

104

Nadkarni, Damle SG

Compared ZOE and Calcium hydroxide on 70 molars for ninemonths

94.28% success with Calcium Hydroxide.


105/122

105

Chawla HS et al

Mixture of Zinc oxide powder 15 gms, Calcium hydroxidepaste ( 1cm) , and distilled water as root canal filling material

for 12 months

The material remained upto the apex till the beginning of

physiologic root resorption Material resorbed at the same rate as the teeth in one case.


106/122

106

Vitapex- Kawakami 1979

Contains calcium hydroxide & Iodoform

Iodoform- 40.4%

Calcium hydroxide- 30.3%

Silicone- 22.4%


107/122

107

Bone regeneration clinically & Histologically (Dominguez ,Block )

Do not set hard so retrieval is easy

Harmless to permanent tooth germs

It is radiopaque (Garcia Godoy )

Bacteriostatic

Rate of resorption faster than phsiological resorption of tooth

Resorbs without ill effects (Garcia Godoy).


108/122

108

Allergic reactions to iodine in some individuals( Castognala)

Discoloration of teeth (Rotstein)

Iodoform irritating to the periapical tissue can cause cemental

necrosis( Erausquin)


109/122

109

Kawakami T

Used Vitapex to find the fate of calcium hydroxide componentin root canal filling paste.

Water based pastes caused necrosis because of high alkalinity

of calcium hydroxide while silicone based paste (VITAPEX)

shows no necrotizing effect.

Comparison of zinc oxide and eugenol,and Vitapex for root canal treatment of


110/122

pnecrotic primary teeth.

Mortazavi M, Mesbahi M Both ZOE and Vitapex gave encouraging results.

overall success rates of Vitapex and ZOE were 100% and

78.5%, respectively

110

Evaluation of various root canal fillingmaterials in primary molar pulpectomies:
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Mortazavi%20M%22[Author]&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Mesbahi%20M%22[Author]&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Mesbahi%20M%22[Author]&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Mesbahi%20M%22[Author]&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Mesbahi%20M%22[Author]&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Mortazavi%20M%22[Author]&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Mortazavi%20M%22[Author]&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Mortazavi%20M%22[Author]&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


111/122

111

materials in primary molar pulpectomies:an in vivo study.

Ozalp N, Sarolu I, Snmez H.

In the ZOE group, all pulpectomies were successful.

In the Sealapex group, two pulpectomies

Calcicur group, four pulpectomies showed complete resorption

of the material in the root canal.

Vitapex group, although six pulpectomies showed resorption

of the filling material within the canals, this had no effect on

the clinical and radiographical success of the treatment.

Report of success rates in root filling in
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Ozalp%20N%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Saro%C4%9Flu%20I%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Saro%C4%9Flu%20I%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22S%C3%B6nmez%20H%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22S%C3%B6nmez%20H%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22S%C3%B6nmez%20H%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22S%C3%B6nmez%20H%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Saro%C4%9Flu%20I%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Saro%C4%9Flu%20I%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Saro%C4%9Flu%20I%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Ozalp%20N%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Ozalp%20N%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Ozalp%20N%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


112/122

112

p gprimary molars

Invest igator Fol lowupMonths

No.of teethexamined

Fi l l ingMaterial

Success Rate%

Gould 7-26 29 ZOE 68.7

Rifkin 12 26 KRI 89.0

Coll 6-36 33 ZOE 80.5

Coll 60-82 29 ZOE 86.1

Garcia

Godoy

6-24 55 KRI 95.6

Reyes 6-24 53 KRI+FC+

Ca(OH)2

100

Barr 12-74 62 ZOE+

FC

82.3

Success of pulpectomy with zinc oxide-e genol s calci m h d o ide/iodofo m


113/122

113

eugenol vs calcium hydroxide/iodoformpaste in primary molars.

Trairatvorakul C, Chunlasikaiwan S.

At 6 and 12 months, the ZOE success rates were 48% and

85%, respectively, and the Vitapex success rates were 78%and 89%

Vitapex appeared to resolve furcation pathology at a faster rate

than zinc oxide-eugenol at 6 months, while at 12 months, both

materials yielded similar results.

Conclusion
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Trairatvorakul%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Chunlasikaiwan%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Chunlasikaiwan%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Chunlasikaiwan%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Chunlasikaiwan%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Trairatvorakul%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Trairatvorakul%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Trairatvorakul%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


114/122

114

Conclusion

REFERENCES


115/122

115

Don M. Ranly; Pulpotomy therapy in primary teeth: new modalities for old

rationales; Pediatric dentistry; 16: 1994; 403-9

D.R. Llewelyn; The pulp treatment of the primary dentition; International

Journal of Pediatric Dentistry; 2000; 10: 248-252

Cheng D.Fong, Martin J.Davis; Partial pulpotomy for immature permanentteeth, its present & future; Pediatric Dentistry 24: 29-32, 2002

Scott A. Fishman, Richard D. Udin, David L.Good, Fairborz Rodef; Success of

electrofulguration pulpotomies covered by zinc oxide & eugenol or calcium

hydroxide: a clinical study; Pediatric Dentistry; 18: 385-90; 1996

Waterhouse PJ; Formocresol & alternative primary molar pulpotomy

medicaments: a review; Endod Dent Traumatol 1995; 11: 157-162

V. Srinivasan, C. L. Patchett, P. J. Waterhouse; Is there life after Buckleys

Formocresol? Part IA narrative review of alternative interventions &


116/122

116

materials; International Journal of Pediatric Dentistry; 2006; 16: 117-127

V. Srinivasan, C. L. Patchett, P. J. Waterhouse; Is there life after BuckleysFormocresol? Part IIDevelopment of a protocol for the management of

extensive caries in the primary molar; International Journal of Pediatric

Dentistry; 2006; 16: 199-206

Peter L. Judd, David J. Kenny; Formocresol Concern; J. Canad Dent Assn,1987; no.5; 401-4

Bradley Lewis; Formaldehyde in dentistry: a review for the millennium; The

Journal of Clinical Pediatric Dentistry; Vol. 22; No. 2/1998

Sharon D. Hill, N. Sue Seale, E. Matthew Quintero, BS Ingrid Y. Guo; The

effect of glutaraldehyde pulpotomy treatment on pulpal enzymes; Pediatric

Dentistry: Sep./Oct. 1993; vol. 15, no. 5; 337-42

Robert J. Feigal, harold H. Messer; A critical look at gluteraldehyde;

Pediatric dentistry: April/ May, 1990; Vol. 12, No. 2; 69-71


117/122

117

D.M. Ranly, Franklin Garcia Gogoy, Diane Horn; Time, concentration &

pH parameters for the use of gluteralhehyde as a pulpotomy agent: an invitro study; Pediatric dentistry: sep. 1987/ vol. 9. No.3; 199-203

Ay- Luen Fei, Richard d. Udin, Ronald Johnson; A clinical study of ferric

sulfate as a pulpotomy agent in primary teeth; Pediatric dentistry;

Nov./Dec. 1991; Vol.13; No.6; 327-32.

Nikki L Smith, N. Sue Seale, Martha E. Nunn; ferric sulfate pulpotomy in

primary molars: A retrospective study; Pediatric Dentistry 2000; 22: 192-

199.

David M.Strange, N. Sue Seale, Martha E. Nunn, Malcolm Strange;

Outcome of formocresol/ ZOE sub-base pulpotomies utilizing alternative

radiographic success criteria; Pediatric Dentistry 2001; 23: 331-336

Derek Zurn, N. sue Seale; Light cured Calcium hydroxide VsFormocresol in human primary molar pulpotomies: A randomizedControlled trial; Pediatric dentistry 2008; 30: 34 31


118/122

118

Controlled trial; Pediatric dentistry 2008; 30: 34-31

A.B.S. Moretti et al, The effectiveness of MTA, calcium hydroxide& formocresol for pulpotomies in primary teeth; InternationalEndodontic Journal, 2008, 41, 547-555

Howard W. Robert, Jeffery M. Toth, David W. Berzins, David G.

Charlton; MTA material use in endodontic treatment: A review ofthe literature; Dental Materials; 24 (2008); 149-164

D. Tuna & A. Olmez; Clinical long term evaluation of MTA as adirect pulp capping material in primary teeth; International

Endodontic Journal; 41; 2008; 273-278

Eliezer Eidelman, Dr. Odont, Gideon Holan, Anna B. Fuks; MTAVs Formocresol in pulpotomized primary molars: a preliminaryreport; Pediatric Dentistry-2001, 23:15-18

Richard S. Schwartz et al; MTA: a new material for Endodontics; JADA1999; Vol.130, 967-975


119/122

119

Neeta T. Prabhu, A.K. Munshi; Clinical, radiographic & histologicalobservation of the radicular pulp following Feracrylum pulpotomy; J.

Clin Pediatr Dent; 1997, 21(2): 151-156

K. Iohara et al; Dentin regeneration by dental pulp stem cell therapy withrecombinant Human Bone morphogenetic Protein2; Journal of DentalResearch; 2004; 83(8): 590-595

Yoshito Yoshimine, Katsumasa Maeda, Fukuoka; Histologic evaluation oftetracalcium phosphate based cement as a direct pulp capping agent;OOOE; 1995; 79: 351-8

Manoj Komath, varma H.K.; Fully injectable calcium phosphate cement- apromise to dentistry; Ind J Dent Res; 2004; 15(3): 89-95

Anna B. Fuks; Vital pulp therapy with new materials for primary teeth:New direction & Treatment perspectives; Pediatr Dent 2008; 30: 211-9

Fuks AB; Pulp therapy for primary dentition. In Pediatric Dentistry:infancy through adolescence; Pediatric Dentistry 2005


120/122

120

Fuks AB, Papaginnoulis L; Pulpotomy in primary teeth: review of

literature; Eur Arch Pediatr Dent 2006;7; 64-71

David E. Witherspoon; Vital pulp tissue with new material: Newdirection & treatment perspectives- Permanent teeth; Pediatr dent2008; 30; 220-4

Alan R. Milnes; Is Formocresol Obsolete? A fresh look at theevidence concerning safety Issues; Pediatr dent 2008; 30; 237-46

Paula Jane Waterhouse; New Age pulp therapy: Personal thoughtson a hot debate; Pediatr dent 2008; 30; 247-52

D. B. Kennedy; Pulp therapy; Kennedys Pediatric OperativeDentistry; Chapter 18,19; 4th edt.; 157-168

Shobha Tandon; Pediatric EndodonticsTreatment Modalities; Textbook ofPedodontics; 2nd edt.; 404-410


121/122

121

Nikhil Marwah; Pediatric Endodontics; Comprehensive Pediatric Dentistry;chapter 20 ;1st edt.; 183-189

John I. Ingle; Pediatric Endodontics; Endodontics; Chapter 17; 5th edt.; 875-889

Jimmy Pinkham; Pulp therapy of Primary dentition; Pediatric dentistryInfancy through Adolescence; Chapter 22; Edt.4; 384-387

Mc Donald; Treatment of deep caries, Vital pulp exposure & pulpless teeth;Dentistry for Child & Adolescent; chapter18; 8th edt.; 397-399

Cohen, Pathways of pulp , Pediatric Endodontics.

THANK U


122/122

Documents

Materials Used in Pediatric Endodontics