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reaction of pulp to various capping materials

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mohamed bayoumi

on 5 November 2013

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Transcript of reaction of pulp to various capping materials

laser (Light Amplification by Stimulated Emition of Radiation)
Reaction of the pulp to various capping materials

presented by: Mohamed Amr Bayoumi
Supervised by: Prof. Mona El Kateb

restorative pediatric dentistry
spring 2013

Formocresol is a compound of formaldehyde, tricresol, glycerin and water
Formocresol was introduced by Buckley in 1904.
It is a formaldehyde compound evolved as the preffered drug for routine endodontics as well as pediatric endodontics
After gaining access to the pulp chamber
•Partial rectified: the pulp tissues are amputated with a sharp excavator or a round bur in a high speed turbine and the electrodes are used to coagulate the radicular pulp tissue
•Fully rectified: the electrodes are used to amputate the infected pulp tissue and coagulate the healthy radicular tissue.
Mode of action:
Creates a superficial zone of coagulation necrosis that remains compatible with the underlying tissue

The rationale for the use of formocresol remains unclear BUT it presumably fixes the affected and infected radicular tissue so that chronic inflammation replaces acute inflammation .
It is the intent of formocresol pulpotomy that the pulp remains in a metastable condition until the tooth is exfoliated.
Mode of action:

It produces superficial tissue fixation by chemical bonding to intracellular protein rendering the tissues metabolically inert.
As aldehyde binds to tissue fluid on one end and amino acid on the other, so it hydrolyses in the tissue
Ubiquity ( present everywhere) of Formaldehyde:
Antibiotics are used in dentistry at least as often as formocresol, and each year
numerous children and adults are injured or die as a result of
allergic or anaphylactic reactions to antibiotics, yet there has been no call for the
elimination of antibiotics from dental practice.
Peroxides for dental bleaching, bonding agents, and solvents used in adhesive
dentistry all demonstrate cytotoxicity in vitro, yet they form an important part of
every dentist’s restorative armamentarium.
Diagnostic radiation is an indispensable component of every dental office, yet
irrefutable evidence exists showing that radiation exposure can induce the
development of cancers.

The estimated formaldehyde dose associated with 1 pulpotomy procedure, assuming a 1:5 dilution of formocresol placed on a no. 4 cotton pellet that has been squeezed dry, is approximately 0.02–0.10 mg.

After exposure of pulp to formocresol.from 1 week to 14 days, 3 distinct zones become evident:
1-Pulp adjacent to the formocresol application site is fixed ( broad acidophilic zone)
2-The middle one third shows loss of cellular integrity which alters the blood flow resulting in areas of ischemia ( atrophy )
3-The apical third shows ingrowth of granulation tissue and broad zone of inflammatory cells

In 2003, studies reported that fibrosis was more extensive at 4 weeks with evidence of calcification in certain samples
Method of application:
A blotted sterile cotton pellet which is carefully squeezed with gauze is applied in the pulp chamber covering all pulp orifices after carefully amputating the pulp tissue and controlling the bleeding.
•Local drawbacks:
1-Chronic inflammatory response or even total necrosis
2-Risk of periapical irritation (why) highly volatile
3-Highly toxic to cells
4-Accelerate bone resorption
5-Increased prevalence of hypoplastic or hypomineralization of the permenant teeth
6-Injury to the developing tooth germ
7-Disorder of eruption
8-Reversible fixation leading to auto-antibody formationwhich leads tomutagenicity and carcinogenicity (repeat)
9-Internal resorption
10-Evidence of causing fibrosis of the remaining radicular pulp tissue which leads to subsequent necrosis
11-Hastens the sequence of eruption of permenant teeth ( increase the rate )
•Systemic drawbacks:
In June 2004, the International Agency for Research on Cancer (IARC) classified formaldehyde as having carcinogenic potential in humans, as there is sufficient evidence which reveals that it causes nasopharyngeal cancer, limited evidence for cancer of the nasal cavity and paranasal sinuses, and strong but not sufficient evidence for leukaemia .
The rationale for electrosurgical pulpotomy is that after the removal of affected coronal pulp tissue, a layer of coagulation necrosis caused by electrosurgery application provides a barrier between healthy radicular tissue and the base material placed in the pulp chamber.
•Partial rectified (coagulation only)
•Fully rectified (cutting and coagulation)

Types of electrosurgery:
•Electrofulguration is a procedure to destroy and remove tissue) using a high-frequency electric current applied with a needlelike electrode
2.Good visability
4.No chemical medicaments
5.Self limiting
6.No systemic effects
1.Heat generation
2.Tissue destruction
3.Persistent inflammation
4.Periapical and furcal radiolucencies
5.Pathological root resorption
i. Histologic studies:

Results reported in an eight week study by Ruemping et al. (1983) indicated that an electrosurgical pulpotomy was comparable to a formocresol pulpotomy in non-carious primary .
In contrast, Shulman et al. (1987) in an in vivo study using 80 non-carious primary teeth of four macaca fascicularis monkeys histologically compared the results of electrosurgery to formocresol from three to 65 days post-treatment.

Based on the histopathological results of the present
study, the Electrosurgical Pulpotomy using Mechanical
Coronal Pulp Removal (ES/MCPR) produced more
favorable results than when using the Electrosurgical
Coronal Pulp Removal (ES/ECPR). Therefore, it
appears that it is important to reduce the heat generated in removing the coronal pulp tissue by utilizing an
electrosurgical pulpotomy technique similar to that
advocated by Mack and Dean
. Clinical and radiographic studies

Mack & Dean (1993), in a retrospective study, evaluated 164 electrosurgical pulpotomies clinically and radiographically over an observation period of up to five years and ten months. They reported a clinical and radiographic success rate of 99.4 percent.
Electrosurgery has not gained widespread acceptance for pulpotomy of vital primary molars in North America (Primosch et al. 1997). The investigations have had relatively short follow-up periods and the results are inconsistent. The outcomes of inflammatory root resorption and pulp necrosis following electrosurgical pulpotomy have limited its further investigation.
Ideally, laser irradiation would create a superficial zone of coagulation
necrosis that remained compatible with the underlying tissue and that isolated the pulp from the various of the sub base.
•Rapid Heamostasis
•Germ destroying effects
•Time efficiency
•Painless treatment
•Effiecient treatment with less trauma

•Excessive heat production
•Healthy tissue destruction
•Persistent inflammation
YAG Laser
•Er:YAG lasers are solid-state lasers whose lasing medium is erbium-doped yttrium aluminium garnet (Er:Y3Al5O12). Er:YAG lasers typically emit light with a wavelength of 2940 nm, which is infrared light
•Nd:YAG (neodymium-doped yttrium aluminum garnet; Nd:Y3Al5O12) is a crystal that is used as a lasing medium for solid-state lasers.
CO2 Laser
The carbon dioxide laser (CO2 laser) was one of the earliest gas lasers to be developed (invented by Kumar Patel of Bell Labs in 1964[1]), and is still one of the most useful. Carbon dioxide lasers are the highest-power continuous wave lasers that are currently available. They are also quite efficient: the ratio of output power to pump power can be as large as 20%.
The CO2 laser produces a beam of infrared light with the principal wavelength bands centering around 9.4 and 10.6 micrometers.

Wilkerson et al. (1996)29, studied the effects of argon laser on primary tooth pulpotomies in swine. They reported that after sixty days, pulps appeared to retain their vitality and capability of normal pulp healing. They also concluded that the use of argon laser pulpotomy did not appear to be detrimental to pulp tissues.
Moritz et al. (1998)30, used CO2 laser in direct pulp capping. Thermal tests were used for vitality assessment and laser Doppler flowmetry for direct measurement of pulpal blood. The last recall examination at 12 months demonstrated that 89 teeth remained vital, corresponding to a success rate of 89%. They concluded that CO2 laser seems to be a valuable aid in direct pulp capping.
This study and others led to the use of laser for pulpotomy in primary teeth for better clinical, radiographic, and histological results, although much research is still needed to investigate this technique taking into consideration the high cost.31
Conclusion: Findings of this investigation show that LLLT can be used successfully as a
complementary step to pulpotomy procedure in order to help the healing of amputated
pulp. Longer follow-up periods are recommended to investigate long-term effect of LLLT
pulpotomy on pulp
classification of pulp therapy according to ranly
devitalization pulpotomy
formocresol pulpotomy
electrosurgical pulpotomy
laser pulpotomy
ANTIMICROBIAL AGENTS USED IN ENDODONTIC TREATMENTMarina George Kudiyirickal, Romana IvanakováCharles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Czech Republic: Departmentof Dentistry
Current and potential pulp therapies for primary and young permenant teethD.M Ranly F. Garcia-Godoy
Is Formocresol Obsolete? A Fresh Look at the Evidence Concerning Safety IssuesAlan R. Milnes, DDS, PhD
Slide share .com Presented by: Reham Mohamed Ali
Alternative Interventions to Formocresol as a Pulpotomy Medicament in Primary Dentition: A Review of the Literature
By: Dr. Jumana Sabbarini BDS, MSc, Jordanian Board In Pediatric Dentistry
Pulp capping materials
Mohamed Salah ShalabyShaima’a Soliman Hozaien
A thesis submitted in conformity with the requirements for the degree of Master of Science in Pediatric Dentistry ,Graduate Department of Dentistry ,University of Toronto , © Copyright by Zahra A. Kurji (2009)
Histological evaluation of electrosurgery and formocresolpulpotomy techniques in primary teeth in dogsOmar El-Meligy* / Medhat Abdalla** / Sahar El-Baraway*** / Magda El-Tekya**** / Jeffrey A Dean*****
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