10/13/2010 Resorption of a CaOH/iodoform paste (Vitapex) in root conal therapy

Resident: J. Hencler
Date: 10/13/2010

Article title: Resorption of a CaOH/iodoform paste (Vitapex) in root conal therapy for primary teeth: A case report

Author(s): Nurko et al
Journal: Pediatric Dentistry-22:6, 2000

Major topic: Vitapex as a root canal medicament in primary teeth
Type of Article: Case report

Main Purpose:
Present a clinical and radiographic follow up (38 months) of pulpectomy treatment performed on maxillary primary anterior teeth using vitapex.

Background:
Resorption of the filling material is one of the requirements of an ideal root-canal medicament for primary teeth. Resorption of the root canal filling material should occur as the primary tooth root is resorbed during exfoliation, permitting normal eruption of the succedaneous tooth. If the material is expressed beyond the apex, it should be resobable and non-toxic to the periapical tissue and permanent tooth germ. Common root canal filling materials for primary teeth include; zinc oxide and eugenol, iodoform paste, and CaOH. Zinc oxide and eugenol is the most problematic because when extruded beyond the apices it sets into hard cement that resists resorption. Disturbances to the succedaneous tooth have been reported and deflection of the perm tooth may occur. Iodoform paste has shown excellent clinical and radiographic results. Vitapex is a viscous mix of CaOH and iodoform. When extruded into furcal or apical areas, vitapex will diffuse and/or be resorbed in part by macrophages. Vitapex is an ideal root canal filler for primary teeth with a easy delivery system.

Case details:
17-month male patient w/ ECC in anterior maxillary teeth and in one primary molar. Occlusal radiograph revealed deep carious lesions involving pulps of the lateral incisors. Dental tx under GA, Teeth #D,G were pulpectomized with Vitapex and restored with Nusmile crowns. An immediate post-op radiograph revealed Vitapex extruded from the apices of #D,G. At 13 months child required tx under GA again. Intra-radicular Vitapex was partially resorbed from #D,G and teeth were asymptomatic with no pathosis. At 16 month, an occlusal radiograph showed complete resorption of the filling material from the canals of #D,G with no signs of clinical and radiographic signs of tx failure. The patient was placed on a 6mrc. 38 months after initial tx, patient presented with chipped esthetic facings on #D,G. When restoring #D,G; the pulp chamber of #D was accessed to take a sample of the pulp chamber with a endo file. Sample was sent to a micro lab where neither anaerobic or aerobic were found in the sample.

Key points in the article discussion:
Because of the anatomy of primary roots and furcal ares, it is difficult to avoid extrusion of filling material beyond the root canals in all pulpectomy cases. This case report confirms that extruded Vitapex can be easily removed from extra-dental sites and the resorption is be a beneficial characteristic in pulpectomies in primary teeth. The effects of intra-radicular resorption are not certain but an unfilled root canal could be a open space for bacterial leakage and infection. Although the canal of the vitapex-treated lateral incisor was free of bacterial contamination, the authors caution overuse of vitapex is certain situations such as cases of acute infection because Vitapex has been shown to have minimal antibacterial properties. Antibiotic therapy may augment tx w/ vitapex. The authors recommended Kri paste (iodoform) may be better suited for more aggressive tx b/c of it’s bactericidal and resorptive properties.

Summary of conclusions:
Vitapex used as a root canal filling material for pulpectomy tx for primary teeth resorbed extra-radicularly and intra-radicularly w/out ill effect and proved to be clinically and radiographically successful.

Assessment of article: Good article and case report.