Clinical and Radiographic Success of Modified Mineral Trioxide Aggregate with Formocresol as Pulpotomy Medicaments in Primary Molars: A Randomized Control Trial
Sonu Acharya, Deepa Gurunathan, Ramya Mani, Lakshmi Thangavelu
Citation Information :
Acharya S, Gurunathan D, Mani R, Thangavelu L. Clinical and Radiographic Success of Modified Mineral Trioxide Aggregate with Formocresol as Pulpotomy Medicaments in Primary Molars: A Randomized Control Trial. World J Dent 2024; 15 (9):777-783.
Objective: This clinical study was aimed to investigate the clinical and radiographic outcomes of modified NeoPutty mineral trioxide aggregate (MTA)® (Nusmile) in primary teeth of children aged 4–6 years.
Materials and methods: An in vivo study was done in children aged 4–6 years old. A total of 50 primary second molar teeth were included in the study, with 25 of them undergoing treatment with a 1:5 dilution of Buckley's formocresol (FC) and 25 receiving treatments with modified NeoPutty MTA® (NeoPutty MTA mixed with triple antibiotic paste). The groups were evaluated at 0, 3, 6, and 12 months for clinical and radiographic outcomes, and results were statistically analyzed.
Results: At 12 months, the modified NeoPutty MTA® pulpotomy group showed a significantly higher success rate clinically (96%) compared to the FC group (72%) (p < 0.05). However, radiographically, although modified NeoPutty MTA® was better (92%) than FC (82%), the difference was not statistically significant. Modified NeoPutty®-treated teeth exhibited no signs of pain or discomfort and demonstrated better pulp vitality compared to the FC group.
Conclusion: Modified NeoPutty MTA® demonstrated superior clinical success rates and better radiographic outcomes compared to traditional FC pulpotomy.
Clinical significance: The newer bioactive material (modified NeoPutty MTA) has been compared with the gold standard (FC) in the pulpotomy procedure in primary molars, as FC has certain disadvantages, that is, carcinogenicity. The success of modified NeoPutty MTA can pave the way for using better materials with fewer disadvantages.
American Academy of Pediatric Dentistry. Pulp Therapy for Primary and Immature Permanent Teeth. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023. pp. 457–465.
Pushpalatha C, Dhareshwar V, Sowmya SV, et al. Modified mineral trioxide aggregate—a versatile dental material: an insight on applications and newer advancements. Front Bioeng Biotechnol 2022;10:941826. DOI: 10.3389/fbioe.2022.941826
Fuks AB. Pulp therapy for the primary dentition. In: Pinkham JR, Casamassimo PS, Fields HW Jr., et al., editors. Pediatric Dentistry: Infancy Through Adolescence. 5th ed. St. Louis, Mo: Elsevier Saunders Co; 2013. pp. 331–351.
Coll JA, Sadrian R. Predicting pulpectomy success and its relationship to exfoliation and succedaneous dentition. Pediatr Dent 1996;18(1):57–63.
Yildiz E, Tosun G. Evaluation of formocresol, calcium hydroxide, ferric sulfate, and MTA primary molar pulpotomies. Eur J Dent 2014;8(2):234–240. DOI: 10.4103/1305-7456.130616
Fei AL, Udin RD, Johnson R. A clinical study of ferric sulfate as a pulpotomy agent in primary teeth. Pediatr Dent 1991;13:327–332.
Gadallah L, Hamdy M, El Bardissy A, et al. Pulpotomy versus pulpectomy in the treatment of vital pulp exposure in primary incisors. A systematic review and meta-analysis. F1000Res 2018;7:1560. DOI: 10.12688/f1000research.16142.3
El Meligy OAES, Alamoudi NM, Allazzam SM, et al. BiodentineTM versus formocresol pulpotomy technique in primary molars: a 12-month randomized controlled clinical trial. BMC Oral Health 2019;19(1):3. DOI: 10.1186/s12903-018-0702-4
Alqahtani AS, Alsuhaibani NN, Sulimany AM, et al. NeoPUTTY® versus NeoMTA 2® as a pulpotomy medicament for primary molars: a randomized clinical trial. Pediatr Dent 2023;45(3):240–244.
AlMotawah FN, Chandra Pani S, AlKharashi T, et al. Comparison of survival rates of stainless-steel crowns placed with and without pulpotomy: a two-year retrospective study. Int J Dent 2020;2020:8883189. DOI: 10.1155/2020/8883189
Soxman JA. Stainless steel crown and pulpotomy: procedure and technique for primary molars. Gen Dent 2000;48(3):294–297.
Issrani R, Prabhu N, Bader AK, et al. Exploring the properties of formocresol in dentistry—a comprehensive review. J Clin Pediatr Dent 2023;47(3):1–10. DOI: 10.22514/jocpd.2023.020
Bhandi S, Okareh OT, Patil S. Local immune response to mineral trioxide aggregate: a narrative review. World J Dent 2023;14(4):382–387. DOI: 10.5005/jp-journals-10015-2208
Moretti ABS, Sakai VT, Oliveira TM, et al. The effectiveness of mineral trioxide aggregate, calcium hydroxide and formocresol for pulpotomies in primary teeth. Int Endod J 2008;41:547–555. DOI: 10.1111/j.1365-2591.2008.01377.x
Markovic D, Zivojinovic V, Vucetic M. Evaluation of three pulpotomy medicaments in primary teeth. Eur J Paediatr Dent 2005;6:133–138.
Niranjani K, Prasad MG, Vasa AAK, et al. Clinical evaluation of success of primary teeth pulpotomy using mineral trioxide aggregate(®), laser and biodentine(TM)—an in vivo study. J Clin Diagn Res 2015;9:ZC35–ZC37. DOI: 10.7860/JCDR/2015/13153.5823
Awawdeh L, Al-Qudah A, Hamouri H, et al. Outcomes of vital pulp therapy using mineral trioxide aggregate or biodentineTM: a prospective randomized clinical trial. J Endod 2018;44:1603–1609. DOI: 10.1016/j.joen.2018.08.004
Juneja P, Kulkarni S. Clinical and radiographic comparison of biodentine, mineral trioxide aggregate and formocresol as pulpotomy agents in primary molars. Eur Arch Paediatr Dent 2017;18:271–278. DOI: 10.1007/s40368-017-0299-3
Agamy HA, Bakry NS, Mounir MMF, et al. Comparison of mineral trioxide aggregate and formocresol as pulp–capping agents in pulpotomized primary teeth. Pediatr Dent 2004;26:302–309.
Stringhini Junior E, Vitcel MEB, Oliveira LB. Evidence of pulpotomy in primary teeth comparing MTA, calcium hydroxide, ferric sulphate, and electrosurgery with formocresol. Eur Arch Paediatr Dent 2015;16(4):303–312. DOI: 10.1007/s40368-015-0174-z
Jayam C, Mitra M, Mishra J, et al. Evaluation and comparison of white mineral trioxide aggregate and formocresol medicaments in primary tooth pulpotomy: clinical and radiographic study. J Indian Soc Pedod Prev Dent 2014;32(1):13–18. DOI: 10.4103/0970-4388.127043
Fuks AB, Bimstein E, Guelmann M, et al. Assessment of a 2 percent buffered glutaraldehyde solution in pulpotomized primary teeth of school children. ASDC J Dent Child 1990;57:371–375.
Huth KC, Paschos E, Hajek-Al-Khatar N, et al. Effectiveness of 4 pulpotomy techniques—randomized controlled trial. J Dent Res 2005;84(12):1144–1148. DOI: 10.1177/154405910508401210