Primary Molar Pulp Therapy - Histological Evaluation of Failure

Resident: Adam J. Bottrill
Date: 01OCT10
Region: Providence
Article title: Primary Molar Pulp Therapy - Histological Evaluation of Failure
Author(s):Waterhouse, P.J.
Journal: International Journal of Pediatric Dentistry
Page #s: 313-321
Year: 2000
Major topic: Primary Molar Pulp Therapy
Minor topic(s): NA
Type of Article: Analysis of extracted primary teeth with failed pulp therapy.
Main Purpose: Provide a qualitative comparison of the clinical, radiographic and histological outcomes in a small sample of cariously exposed primary molars, extracted after unsuccessful pulp treatment by two vital pulpotomy methods.

Key points in the article discussion:

I. General:

A. Primary molars extracted due to treatment failure during a longitudinal clinical investigation of the efficacy of formo (F) vs CaOH (C) powder.
1. 52 child patients (26m, 26f)
2. Randomly allocated to the formo or CaOH group.
3. Coronal pulp amputation recommended only in teeth with vital, cariously exposed pulp tissue.
4. 79 cariously-exposed primary molars were tx planned for pulp therapy.
a. 44 in F group... 35 in C group.
5. 6 Teeth were extracted... only 5 were intact enough for evaluation.

II. Results:

A. Both Groups...
1. Resorption of reactionary dentin
2. Dentin barrier formation
3. Root canal narrowing due to reactionary dentin formation
4. Pus cells

II. Conclusion:

A. Histological findings "may indicate possible reasons for treatment failure".

B. Clinical and radiographic findings "correlate well with the histological findings."

C. Recommendations:
1. Radiographic monitoring of teeth with pulp therapy is necessary. (Check!)
2. During coronal pulp amputation, if hemostasis can't be achieved tooth should be treated with pulpectomy or extraction (Really?!)
3. Restorations should be well-placed and monitored for signs of inadequate seal. (No kidding!!)

D. Allow me to translate... The conclusions and recommendations do not logically follow the title or purpose of the article. This paper hasn't provided any further insight on the difference between these two Tx modalities... I know, it sounds harsh, but I don't find this article particularly significant.

Assessment of article: SHE...NAN...I...GANS.