Ferric sulfate pulptomy in primary molars: A retrospective study

Meghan Sullivan Walsh October 2, 2010

Literature Review - St. Joseph/LMC Pediatric Dentistry

Ferric sulfate pulpotomy in primary molars: A retrospective study

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Ferric sulfate pulpotomy in primary molars: A retrospective study

Authors: Nikki L. Smith, DDS, MS; N. Sue Seale, DDS, MSD; Martha E. Nunn, DDS, PhD

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 22:3, 2000, pages 173-180

Major Topic: Success rate of pulpotomies performed using ferric sulfate on primary molars.

Overview of Method of Research: Retrospective study of chart reviews and radiographic data from patients receiving ferric sulfate pulotomies.

Findings: Clinical and radiographic data from a retrospective chart review was collected on 242 primary molars in 171 children receiving ferric sulfate pulpotomies. Data was collected from a private practitioner’s office in Fort Worth, Texas over a five year period (1994 to 1998) and reviewed for clinical success. The study sample comprised of patients with at least one primary molar treatment planned for vital pulpotomy. The criteria were as follows 1) primary teeth with a vital carious exposure with pulp tissue that bled upon entering the pulp chamber, 2) no clinical symptoms or evidence of pulpal degeneration, to include swelling or presence of a sinus tract, 3) a restorable tooth with a posterior stainless steel crown that remained intact at future recalls until the tooth exfoliated or was extracted, and 4) patients who returned for at least one recall visit following the pulpotomy. All molars were treated with RDI, caries removal and coronal access with a 330 high speed with water spray. Hemostasis was obtained with 15.5% solution of ferric sulfate for 10-15 seconds. The pulpal stumps were rinsed, dried with a cotton pellet and covered with zinc oxide-eugenol cement and a stainless steel crown. The radiographic criteria used to describe clinical findings were unremarkable external root resorption, internal root resorption, interradicular bone destruction, calcific metamorphosis, periapical bone destruction, uneven root resorption, early eruption and root perforation. Success was determined as absence of pathological internal or external root resorption, furcation or periapical radioleucency and root perforation. Clinical success was scored if the tooth had no symptoms of pain, tenderness to percussion, swelling, fistula or mobility. The pathological/radiographic success rates of these teeth ranged from 80% at 4-12 months to 74% at >36 months. The clinical findings and success rates were 99% with only 5 teeth extracted due to clinical symptoms and another 4 extracted due to pathological findings. No hypoplastic or hypocalcified areas were noted on the succedaneous teeth. No significant differences were discovered on a type of primary molar on either arch.

Key Points: Summary: Clinical successes in this study were found to be exceptionally high. However, the radiographic/pathological success was low especially compared to recent findings on ferric sulfate pulpotomies and studies comparing formocresol. The most common pathological findings in this study were internal resorption and calcific metamorphosis. The practitioner in this study chose to observe teeth displaying internal resporption instead of extracting these teeth as failures. This practice allowed observation of interesting radiographic changes over time not previously recorded. Interestingly enough these teeth did not seem to interfere with exfoliation time or normal root resorption. If internal resorption was not classified as a failure than the percentages of success for this study would have been higher. The results of this study might indicate our need to redefine success vs failure when evaluating pulpotomies. Defining osseous changes verse clinical changes may be a more realistic measure of defining a successful pulpotomy.

Assessment of the Article: This was a great study and I believe the success rates of ferric sulfate are more accurately described and measured in this article (74-80%.) Ferric sulfate is a great alternative to formocresol, however, I am not convinced that it is a superior medicament nor has the success that a traditional pulpotomy with formocresol has had for our patients for all this time. With more parents concerned about dental materials and requesting and asking about harmful effects of these medicaments, I believe it is good for us as clinicians to offer choices for our patient’s families. However, I believe more research and studies should be performed comparing these medicaments in order for clinicians to help our patient’s parents make a better choice based on accurate success rates and real knowledge concerning side effects of either material.