Ferric Sulfate Pulpotomy vs RCT in Primary Molars

Resident: Swan

Article Title: Long-term Outcomes of Primary Molar Ferric Sulfate Pulpotomy and Root Canal Therapy

Author: Casas, et al.

Journal: Pediatric Dentistry

Volume (Number): 26:1 2004

Major Topic: Ferric Sulfate Pulpotomy vs. Root Canal Therapy in Primary Molars

Type of Article: Scientific; a prospective, random, controlled trial

Main Purpose: Compare long-term outcomes (>3 years) for vital primary molars treated with ferric sulfate pulpotomy and root canal therapy

Overview of method of research: Healthy children with 1 or more primary molars with caries likely to produce an exposure on removal were included. Total enrollment was 291 primary molars in 130 patients. FS group had 182 molars in 86 patients, RCT group had 109 molars in 54 patients. PA radiograph was taken for each of the molars prior to treatment. Pulp therapy technique was randomly assigned to each child.

Root canal procedure: pulp chamber accessed, coronal pulp amputated using round bur, pulp tissue removed using files, short of the apex. Canals irrigated, air-dried using air-water syringe. Obturation using Sedanol (fine grained, non-reinforced ZOE). Restored with SSC.

Ferric Sulfate Pulpotomy procedure: Accessed, coronal pulpal tissue removed using slow speed/round burs, 16% Ferric sulfate gently burnished on pulp stumps for 15 seconds, chamber flushed with water. If bleeding hadn’t stopped at this point, molar was eliminated from study. With hemostasis, chamber was sealed with fortified ZOE. Restored with SSC.

36 month follow-up: If molar was still present, 4 things recorded 1) missing restorations 2) recurrent decay 3) mobility 4) percussion sensitivity. Soft tissue abnormalities/pathologies noted. PA radiograph of each tooth taken with subsequent categorizations by two pediatric dentists not previously involved; 1) normal molar, no radiographic changes 2) radiographic changes associated with normal physiologic resorption 3) pathologic radiographic change not requiring immediate extraction 4) pathologic change, immediate ext recommended.

Findings: Final sample=29 molars (29 patients; where one pt had multiple treatments, only one tx was evaluated) No statistically different observations of widened PDL space, PA/furcal radiolucencies, or pathological root resorption between the two techniques. PCO was most common radiographic finding for FS treated molars.

“Survival”=molar was not extracted during recall interval or prematurely exfoliated. 3 year probability of survival for FS molars was .62, probability for RCT molars was .92.

Key Points/Summary: Survival curves for both groups were similar until about 24 months post treatment. After that, the FS molars demonstrated decreased survival that was statistically significant.

RCT treated vital primary molars had greater survival than vital primary molars treated with FS, 3 years post-treatment.

Assessment of Article: I liked the study. The authors point out that it’s logistically very hard to come up with a huge, randomly selected group of samples over a long time period. Most get lost in follow-up. I think this was a good effort, even though 10 percent of the molars treated were actually analyzed 3 yrs later. It’s a great point to build from. All this being said and with the results in mind, most clinicians will probably still choose pulpotomy as their tx of choice because of reliability, technical ease, and time required.