Vital pulp therapy with new materials for primary teeth: New directions and treatment perspectives

Author(s): Fuks, A
Journal: Pediatric Dentistry
Volume (number): 30/NO3
Month, Year: May/June 2008
Major topic: Vital pulp therapy
Minor topic(s:
Type of Article: A review
Main Purpose: To review the different forms of vital pulp therapy and the different medicaments that can be used.
Overview of method of research: N/A
Findings: Indirect pulp treatment has been reported in several articles as a successful technique in primary teeth and it is now recommended as an appropriate technique in symptom-free primary teeth with deep caries as long as a proper leakage-free restoration is placed. Direct pulp capping is still not recommended for primary teeth but can be successful on immature permanent teeth. Although a recent article has shown some success with direct pulp caps in primary teeth using MTA. Pulpotomy is still the most common technique used for symptom-free cariously exposed primary molars. In 2004 the International Agency for Research on Cancer classified formaldehyde as a carcinogenic for humans. It has also been determined that there is sufficient evidence that formaldehde causes nasopharyngeal cancer in humans, and “strong but not sufficient evidence” for leukemia. Another study published stated that formaldehyde is not a potent human carcinogen if there is minimal exposure. Currently, there is no correlation between formocresol pulpotomies and cancer. Many studies have been done comparing formocresol and MTA, formocresol and ferric sulfate, and formocresol and calcium hydroxide with varying result. See chart on 214 for summaries. MTA showed better results than FC in all cases. Ferric Sulfate was comparable to FC. Calcium hydroxide had less favorable results than FC. Sodium hypochlorite has been used recently with promising results but the study had a small sample size and a short 1 year follow-up.
Key points/Summary: There are many different ways to treat vital pulps and review articles like this help us to compare the different treatment modalities available.
Assessment of article: A must read article! A quick side note: At an office visit I did recently in Las Vegas the pediatric dentists were using hydrogen peroxide as the medicament for pulpotomies and have been doing that for years and are very happy with it.