Success of Pulpectomy With Zinc Oxide-Eugenol Vs Calcium Hydroxide/Iodoform Paste in Primary Molars: A Clinical Study

Article title: Success of Pulpectomy With Zinc Oxide-Eugenol Vs Calcium Hydroxide/Iodoform Paste in Primary Molars: A Clinical Study

Author(s): Trairatvorakul & Chunlaslkaiwan.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2008. 30:4. 303-307.

Major topic: ZOE vs. Calcium Hydroxide/Iodoform Pulpectomy

Overview of method of research: Clinical Study

Purpose:
To compare the clinical and radiographic success rates of ZOE cement and Calcium Hydroxide/Iodoform paste (Vitapex).

Background:
ZOE is the most popular root canal filling material in primary teeth.
Previous studies have shown that residual filling material may alter the path of eruption in up to 20% of cases.

Methods:
54 mandibular primary molars in 42 subjects between the ages of 3 and 7 years old needing a pulpectomy were recruited. Carious pulp exposure with unsuccessful hemostasis after coronal pulp removal, mobility not associated with normal exfoliation, spontaneous pain, swelling, chronic apical abscess or fistula, percussion sensitivity, pathological resorption, furcal radiolucency, and discontinuity of lamina dura in radiograph were used as inclusion criteria for this study. Teeth with obliterated root canals, internal resorption and physiologic root resorption of more than 1/3 of its length were excluded. Legal guardians consented for patient to either receive ZOE or Vitapex which were assigned to teeth via block randomization. One pediatric dentist performed all treatment using a rubber dam, barbed broaches, an electronic apex locator, K-Files, irrigation with 2.5% sodium hypochlorite and filled with the corresponding filling material with lentulo spirals. Each tooth was then restored with an SSC and a radiograph was taken in the same appointment. Another single investigator performed follow-up exams at 6 and 12 months.
Clinical success was defined as the absence of pain, swelling, fistula, redness, and abnormal mobility. Radiographic success was demonstrated with the continuity of the lamina dura, reduction in the size of pathologic radiolucencies or evidence of bone regeneration. In addition to success and failure, a third category of further observation was included for teeth demonstrating an absence of change in size of radiolucency or continuity of lamina dura as they could not be classified at this time and needed a longer follow-up period.

Findings:
The overall success rates of ZOE at 6 and 12 months were 48% and 85% respectively while Vitapex demonstrated success rates of 78% and 89%. The difference is only significantly significant for radiographic success at 6 months.
All teeth could be classified in two categories prior to treatment: discontinuity of the lamina dura and furcation pathology involving more than half the length of the shortest root. When comparing these groups, there was no significant difference in the severity of the preoperative infection and the success of teeth treated with either ZOE or Vitapex.
At 6 months, 26 of the 27 teeth in ZOE group showed clinical success (96%) whereas Vitapex teeth showed 100% success rate. At 6 months radiographic success was demonstrated in only 48% of the ZOE teeth with another 37% needing further observation. 9 of the 10 requiring further observation were later found to be successful. The Vitapex group showed 78% success and 11% needed further observation.
All six of the failed teeth were in the preoperative category with the most severe radiographic
pathology. The 3 clinical failures were related to tooth mobility only.

Key points/Summary:
Success rates of 78% for Vitapex and 48% for ZOE at 6 months show Vitapex seems to improve furcal and root pathology more quickly.
After 12 months the two filling materials demonstrate comparable success rates.

Assessment of Article:
Although the article had some interesting findings that were consistent with other studies, matched paired samples in the same patient would have been better. But the only significant finding was actually skewed due to the need for further observation in several teeth.