Resident: Cho
Author(s): Primosch et al.
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2005. 27. 470-477.
Major topic: Vital pulpectomy, Zinc oxide-eugenol paste, Primary incisors
Minor topic: Composite resin crowns
Type of Article: Scientific Article
Main Purpose:
The purpose of this study was to evaluate the clinical and radiographic success of ZOE pulpectomies in vital maxillary primary incisors successfully maintained with composite resin crowns.
Overview of method of research:
A retrospective study was conducted using active patient charts from a pediatric dentist. Patients were identified that had pulpectomies on primary maxillary incisors with vital pulp tissue subsequent to dental caries or trauma. To be included in the study, the incisor needed to be vital (by clinical history, radiographic history, presence of bleeding during extirpation of the pulp), successfully restored with a composite strip crown that remained intact, had diagnostic radiographs for preoperative, immediate postoperative, and recall appointments of at least a 6-month interval, had an identifiable outcome (success or failure) by clinical and radiographic findings.
All pulpectomies were completed by a single operator and completed with the following steps:
RDI, all carious tooth structure removed, pulp tissue removed by broach, root canal cleaned with files, irrigated with water syringe and dried, treated with formocresol-soaked paper point, dried with paper points, obturated with ZOE paste mixed with zinc acetate accelerator crystals, canal orifice sealed with TERM Endo Stop, full-coverage restoration completed by acid etch+bond+composite resin strip crown (if there was insufficient tooth structure for retention, resin-based core build up was placed; if there was inadequate crown height, cervical gingivectomy performed), and immediate post-operative radiograph was taken.
A single examiner evaluated the radiographs. The immediate postoperative radiograph was evaluated for filling extent. The recall radiograph was evaluated for success/failure based on clinical and radiographic findings, degree of physiological root resorption, canal filling extent, and eruption status of the succedaneous tooth.
A tooth was considered to be successful if it was asymptomatic with normal radiographic appearance. A tooth was considered a failure if clinically it had spontaneous pain, percussion sensitivity, parulis/fistula present and if radiographically it had an apical lucency and internal and/or external inflammatory root resorption.
Findings: 48 patient charts with 104 pulpectomized primary maxillary incisors were analyzed in this study. 80 of the incisors were treated due to caries; 24 of the incisors were treated due to trauma. The mean age at the time of treatment was 34 months old. The mean followup time was 18 months after initial treatment. 76% of the incisors were determined to be successful. 75% still had complete root formation and the remaining had various stages of physiologic root resorption.
Key points/Summary:
76% of the incisors were determined to be successful that were treated with ZOE pulpectomy. Incisors treated secondary to dental trauma failed in 42% of the cases compared to 19% for those treated secondary to dental caries. Incisors restored with composite crown failed at a higher rate than those treated with a composite core underneath the composite crown. Gross overfill of ZOE paste beyond the confines of the root canal had high failure rates. Delayed eruption of succedaneous teeth occurred more frequently with failed pulpectomies.
Assessment of Article: Good article. It discussed the shortcomings of the results. Example, even though initial gross overfilled incisors had a 80% failure rate, the article pointed out that number of overfilled incisors was only 5 teeth. The article made me wonder if the ZOE used in the pulpectomies had an influence on the durability of the composite crown.
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