Light Cured CaOh2 vs Formocresol in Human Primary Molar Pulpotomies: A Randomized Controlled Trial

Department of Pediatric Dentistry
Resident’s Name:Murphy Program: Lutheran Medical Center - Providence
Article title: Light Cured CaOh2 vs Formocresol in Human Primary Molar Pulpotomies: A Randomized Controlled Trial
Author(s): Zurn, DDS MS Derek, N. Sue Seale DDS, MSD
Journal: Ped. Dent
Year. Volume (number). Page #’s: 2008. v30 No1. 34-41
Major topic: Formo(FC) vs CaOh2
Minor topic(s): Follow up criteria to determine success or failure
Main Purpose: Compare light cured CaOH2 with diluted FC for it’s success as a primary molar pulpotomy medicament

Overview of method of research: Selection criteria had to have included two matching, asymptomatic, contralateral primary molars requiring vital pulps. Matched teeth in each separate patient were randomly selected to either receive FC or CaOH. The teeth were then followed for one year. Two blinded, calibrated examiners evaluated and scored the teeth radiographically and clinically.

CaOH2 Teeth
-Pulp chamber was removed
-CaOH2 was placed and light cured
-Resin modified glass ionomer (vitremer) was placed to restore the chamber
-SSC placed

FC Teeth
-Pulp chamber was removed
-FC dampened cotton pellet was placed for 5 min
-ZOE paste was placed to restore pulp chamber
-SSC placed

Teeth were then followed up at 7-12 months, 13-24 months

Findings:
FC, first introduced by Buckley in 1904, has been the medicament of choice for pulps for some time. As discussed in my article last week, recently physicians have been looking for an alternative to FC due to it’s carcinogenicity. One possible alternative that has been proposed is CaOH2. Radiographically, the results favored the FC group after 7-24 months. Clinically, success was similar between the groups for the first 12 months, but then favored the FC group after 12 months. The response of a tooth treated w/ FC vs CaOH2 is completely different. With FC, no healing response is indicated. It essentially seers off the tissue where it was placed, and the need for healthy radicular pulp is far less dependent. With CaOH2, this is not the case. A healthy radicular pulp is needed to allow healing to occur via a reparative dentinal bridge.

Key points/Summary:
While a need to replace FC is great, this study illustrates that CaOH2 will not be the knight in shining armor. Clinically it is not a viable alternative to FC. After 12 months, success rates for FC were 94%, and for CaOH2 were 56%. The study did however prove that in terms of radiographic scoring, minimal radiographic changes that occur over time may be observed, and not considered failures.

Assessment of Article: A more in depth look at FC vs CaOH2 than my article last week. This article did have some weak points ie Sample size, strict patient criteria, some kids being treated in the OR as opposed to the clinic, thus compromising FU appts, etc. For boards, the things to remember are thatCaOH2 is not an alternative for us to use, and that minor radiographic changes over time are not necessarily failures.