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medicaments can be used in pulpotomy In primary teeth :
Mineral trioxide aggregate (MTA).
The greatest benefit of Ca(OH)2 is the stimulation of reparative dentin bridge, due to a high alkalinity, which leads to enzyme phosphatase being activated and thus releasing of inorganic phosphate from the blood (calcium phosphate) leading to formation or dentinal bridge. It also has an antibacterial action. When calcium hydroxide is applied directly to pulp tissue, there is necrosis of the adjacent pulp tissue and inflammation of the contiguous tissue. Compounds of similar alkalinity cause liquefaction necrosis when applied to pulp tissue. Internal resorption may occur after pulp exposure and capping with calcium hydroxide. Calcium from Dentin Bridge comes from the blood stream. The action of calcium hydroxide to form Dentin Bridge appears to be a result of low grade irritation in the underlying pulpal tissue after application.
Radiographic study,103 teeth
Success rate of 31%.
Among the unsuccessful teeth, 69% showed evidence of
The high failure rate in calcium hydroxide pulpotomies can be attributed to:
Calcium hydroxide has no beneficial
effect on the inflamed pulp.
The creation of an extrapulpal blood cloth.
Its mechanism of action is the cauterization of the superficial pulp tissue
A layer of coagulation necrosis that is caused by the electrosurgery application, provides a barrier between healthy radicular tissue and any base material placed in the pulp chamber. The odontoblasts are stimulated to form a dentin bridge and the tooth is
maintained in the arch with vital radicular tissue until it exfoliates
It creates a superficial zone of
coagulation necrosis that
remains compatible with the
pulps retain their vitality and
capability of normal pulp
Has been suggested as an alternative to formocresol as a pulpotomy agent , based on
its superior fixative properties, low antigenicity, and low toxicity.
high molecular weight that limits its tissue penetration.
has a self limiting penetration, hence, reduces the extent of inflammatory response.
superficial fixation with very little underlying inflammation.
• In a 2% solution destroys fungi, viruses, and bacteria.
•It is considered to be better than formocresol since:
GA does not diffuse trough the apical foramen.
GA does not penetrate the periapical tissues as formocresol.
However, the material/technique was not well accepted by the pediatric
Biological non pharmacological material that may induce tissue healing.
Biological mineral formation initiates within collagen fibers
Collagen gels may provide an appropriate scaffolding for tissue formation.
Substantial tissue healing with an acid soluble autologous skin collagen solution.
•Animal product (skin)
•May cause allergies (to tissue or to
•A commercial preparation of collagen was associated with pulpal inflammation and
•Naturally sourced collagen is not a promising material for biological
approaches to vital pulp therapy.
mineral trioxide aggregate
Promotes regeneration of original tissues when it is placed in contact with the dental pulp or periradicular tissues.
Not been found to induce internal resorption, which has been observed in teeth treated with some other medicaments.
MTA is a fine hydrophilic powder Consists of tricalcium silicate, tricalicum
aluminate, tricalcium oxide, silicate oxide and bismuth oxide.
•Each pack of MTA comes with a pre measured unit dose of water for convenience in mixing.
mineral trioxide aggregatePortland cement may serve as an effective and less expensive
MTA substitute in primary molars pulpotomies.
formocresol (full strength or diluted)
Excellent clinical success
•Releases formaldehyde which may diffuse trough the pulp fixating (mummify)
•Does not promote pulp The rationale of fixation is that we may create a tolerable irritation which replaces an intolerable infection caused by bacteria.
Is a nonaldehyde agent that produces haemostasis at pulp stumps by
chemically sealing blood vessels.The haemostasis takes place by
agglutination of blood protein, without the presence of a blood clot, which suggested that preventing clot formation .Induces favorable histological results in the form of secondary dentin and bridging.Retention of maximum vital
tissue and virtual conservation of the radicular pulp without induction of reparative dentin.
97 % and 94.1 % clinical and radiographic success respectively, follow
up for 6 to 64 months.
(n=69): 85.5and 78.3% clinical and radiographic success respectively, follow up for 9 to 66 months.Currently available evidence suggests
MTAcompared to FC
FS and CHresulted in significantly higher clinical and radiographic success
induces less undesirable responses and may be FC’smost suitable
MTAis superior to CHand equally effective as a pulpotomy dressing in primary mandibular molars . Internal resorption was the most common radiographic finding up to 24 months after pulpotomy.
Portland cement may become the material
of choice for pulpotomies in primary teeth.
Success %ElectrosurgeryClinical 96% Radiographic 84%
Clinical 100% Radiographic92%
In human carious primary molars with reversible coronal pulpitis, pulpotomies performed with either formocresol or ferric sulfate
are likely to have similar