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CASE REPORT
Year : 2017  |  Volume : 5  |  Issue : 2  |  Page : 48-52

Clinical and radiographic evaluation of primary molars treated with biodentine pulpotomy: A series of eight case reports


Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India

Date of Web Publication14-Nov-2018

Correspondence Address:
Dr. P Poornima
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njecp.njecp_15_16

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  Abstract 


A wide array of materials have been used in the past as pulpotomy medicaments including calcium hydroxide, formocresol, and mineral trioxide aggregate. However, none of these are considered ideal as each has its own disadvantages. In the recent years, Biodentine has been considered a promising material for pulpotomy of primary molars owing to its superior physical and biological properties. This article describes a series of eight case reports on clinical and radiographic evaluation of primary molars treated with Biodentine pulpotomy with a follow-up of 3, 6, and 9 months.

Keywords: Biodentine, primary molars, pulpotomy


How to cite this article:
Poornima P, Shagun S, Roopa K B, Neena I E. Clinical and radiographic evaluation of primary molars treated with biodentine pulpotomy: A series of eight case reports. Niger J Exp Clin Biosci 2017;5:48-52

How to cite this URL:
Poornima P, Shagun S, Roopa K B, Neena I E. Clinical and radiographic evaluation of primary molars treated with biodentine pulpotomy: A series of eight case reports. Niger J Exp Clin Biosci [serial online] 2017 [cited 2018 Dec 16];5:48-52. Available from: http://www.njecbonline.org/text.asp?2017/5/2/48/245404




  Introduction Top


Pulpotomy is the most commonly used treatment to maintain primary molars with chronic reversible pulpitis which otherwise would be extracted. Its objective is to preserve radicular pulp, avoid pain and inflammation, and maintain the tooth.[1]

Over the years, a wide variety of materials have been used as pulpotomy medicaments. Calcium hydroxide was the first agent in this context; however, it is not recommended in primary dentition owing to its high alkalinity causing necrosis, inflammation, and dystrophic calcification in the pulp tissue leading to internal resorption.[2] Sweet introduced formocresol as pulpotomy dressing that has been widely used in primary molars for several decades. Its potential carcinogenic and mutagenic effects have limited its use as pulpotomy medicament.[3]

Mineral trioxide aggregate (MTA) is a fine hydrophilic powder developed by Torabinejad in 1993 at Loma Linda University. It has superior biocompatibility and is less cytotoxic than other materials traditionally used in pulp therapy.[4] However, its disadvantages such as high cost, difficult handling characteristics, long setting time, and potential of discoloration have led to the development of new calcium silicate-based material such as Biodentine.[5]

Biodentine™ with active biosilicate technology was announced by the dental material manufacturer Septodont and made commercially available in 2009. The powder mainly consists of tricalcium and dicalcium silicate, calcium carbonate, and zirconium dioxide as a contrast medium. The liquid consists of calcium chloride in an aqueous solution with an admixture of modified polycarboxylate. It has a wide range of clinical applications including apexogenesis, apexification, revascularization, root perforations, pulpotomy, pulp capping, and retrograde-filling material in endodontic surgery and as a dentin-replacement material in restorative dentistry.[6]

The present article describes a series of eight case reports on clinical and radiographic evaluation of primary molars treated with Biodentine pulpotomy with a follow-up of 3, 6, and 9 months.


  Case Report Top


All the patients included in the case series reported with a chief complaint of either pain in the tooth which subsided on removal of the stimulus or decayed tooth [Table 1].
Table 1: Details of the eight cases

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The criteria for tooth selection for pulpotomy were as follows:

  1. Vital primary molars with carious or iatrogenic exposure of the pulp
  2. Lack of clinical evidence of pulpal degeneration (pain on percussion, history of swelling, or sinus tracts)
  3. Absence of radiographic changes of internal/external resorption and furcation radiolucency (preoperative radiograph)
  4. Restorable molars.


Before the procedure, approval was obtained from the ethics committee, and written informed consent was taken from the parents. After administering local anesthesia, the tooth was isolated with a rubber dam. All caries were removed and coronal access was gained using a sterile No. 330 high-speed bur (Mani, Utsunomiya, Japan) with water spray to expose the pulp chamber [Figure 1]a. A spoon excavator (GDC) was used for coronal pulp amputation. A sterile cotton pellet moistened with distilled water was placed over the pulp stumps, and light pressure was applied for 5 min for obtaining hemostasis. The pulp stumps were then covered with Biodentine (Septodont, France) material, obtained after mixing the powder and liquid in a triturator for 30 s to make a thick layer of 1–1.5 mm [Figure 1]b. The mixture was compressed against the exposure site with a moist cotton pellet. After waiting for 12 min to allow the material to set, the cavity was restored with glass ionomer cement (GC FUJI IX) [Figure 1]c. Within 1 week, the tooth was restored with a preformed stainless steel crown. All the cases were followed up till 3, 6, and 9 months after the procedure [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9].
Figure 1: Pulp exposure, placement of Biodentine, glass ionomer cement restoration. (a) Pulp exposure. (b) Placement of Biodentine. (c) Glass Ionomer Cement restoration

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Figure 2: Case 1 – Preoperative, 3, 6, and 9 months of follow-up

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Figure 3: Case 2 – Preoperative, 3, 6, and 9 months of follow-up

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Figure 4: Case 3 – Preoperative, 3, 6, and 9 months of follow-up

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Figure 5: Case 4 – Preoperative, 3, 6, and 9 months of follow-up

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Figure 6: Case 5 – Preoperative, 3, 6, and 9 months of follow-up

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Figure 7: Case 6 – Preoperative, 3, 6, and 9 months of follow-up

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Figure 8: Case 7 – Preoperative, 3, 6, and 9 months of follow-up

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Figure 9: Case 8 – Preoperative, 3, 6, and 9 months of follow-up

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  Discussion Top


As depicted in [Table 2] and [Table 3], good clinical and radiographic success at 3, 6, and 9 month follow-up was recorded in seven out of eight cases in the present case series. However, in one case (case no. 7), periodontal ligament widening and furcal radiolucency were seen at 3, 6, and 9 months of follow-up. The choice of medicament used in pulpotomy procedures is influenced by a number of factors including pulp healing potential, antibacterial properties, mechanical properties, biocompatibility, cytotoxicity, dimensional stability, and handling properties.
Table 2: Clinical parameters assessed

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Table 3: Radiographic parameters assessed

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In search of ideal pulpotomy medicament, materials such as formocresol, ferric sulfate, glutaraldehyde, calcium hydroxide, adhesive liners, enamel matrix derivative, MTA, bioactive glass, bone morphogenetic protein, growth factors, pulpotec, and collagen and other techniques such as electrosurgery and lasers had been tried out with variable clinical, radiological, and histological success for pulpotomy procedure in both primary and permanent dentitions.[7]

Previously, formocresol was the most widely used pulpotomy medicament. However its usage has been limited in the recent years because of the evidence gained from animal testing indicating the mutagenic, carcinogenic, immunogenic and toxic potential of formaldehyde.[8]

Many studies have addressed MTA as a potential alternative to formocresol pulpotomy in primary teeth. These studies showed 100% success rate of MTA, both clinically and radiographically, through different follow-up protocols.[9],[10] It is a biocompatible material and its sealing ability is superior to amalgam or zinc oxide eugenol. It also has the ability to stimulate the release of cytokines from bone cells, which demonstrates the active assistance of MTA in hard-tissue formation.[11] However, slow setting kinetics and complicated handling rendered MTA pulpotomy technique sensitive and restricted its use to specialists.[5]

Biodentine is a calcium silicate-based product which became commercially available in 2009. It has some superior features over MTA: better consistency suited to clinical use, its presentation ensures better handling and safety, as the setting is faster, and there is a lower risk of bacterial contamination, in addition to its ability to be used as a dentine substitute. Therefore, its use is advantageous for both the clinician and the patient.

Calcium silicate-based cements are known to release during setting and for a long period of time thereafter significant amounts of calcium hydroxide ions, responsible for triggering pulp reparative processes. Histological studies have shown the formation of a homogeneous dentin bridge at the pulp exposure site after direct or indirect capping with Biodentine. Its ability to trigger reparative dentin formation and its antibacterial properties are two factors ensuring long-term preservation of pulp vitality. While the antibacterial activity may be due to the alkaline pH, the induction of reparative dentin seems to be due to a release of transforming growth factor-ß1 from pulp cells.[12]

Various studies have reported a high success rate of Biodentine used as a pulpotomy medicament, stating it as a favorable and promising alternative for the existing pulpotomy medicaments. Kusum et al. conducted a study on the clinical and radiographical evaluation of MTA, Biodentine, and propolis as pulpotomy medicaments in primary teeth. They concluded that the clinical success rates obtained by the teeth in the respective groups over 9 months follow-up period were 100%, 100%, and 84%, respectively whereas the radiographic success rates obtained by the teeth in the respective groups over 9 months follow-up period were 92%, 80%, and 72%, respectively.[13] Another study was conducted by Niranjani et al. on clinical evaluation of success of primary teeth pulpotomy using MTA, laser, and Biodentine. The authors concluded that pulpotomies performed with either MTA, laser, or Biodentine are equally efficient with similar clinical/radiographic success and hence can be considered as alternatives to formocresol.[14] A study was done by El Meligy et al. to assess the clinical and radiographic success of formocresol and Biodentine pulpotomy in primary molars, with 3 and 6 months of follow-up. They concluded that both MTA and Biodentine showed 100% success rate.[15]


  Conclusion Top


Biodentine has become the material of choice for various therapeutic purposes worldwide since its launch in 2009. Majority of the studies done are in favor of this product, despite a few contradictory reports. As shown in the present case series, though further research is necessary, Biodentine appears to be a promising material for clinical dental procedures as it is biocompatible and easy to handle with short setting time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
American Academy of Pediatric Dentistry. Guideline on pulp therapy for primary and young permanent teeth. Ref Man 2009;33:112-9.  Back to cited text no. 1
    
2.
Magnusson B. Attempts to predict prognosis of pulpotomy in primary molars. Bacteriologic and histologic examination. Scand J Dent Res 1970;78:232-40.  Back to cited text no. 2
    
3.
Eidelman E, Holan G, Fuks AB. Mineral trioxide aggregate vs. Formocresol in pulpotomized primary molars: A preliminary report. Pediatr Dent 2001;23:15-8.  Back to cited text no. 3
    
4.
Schmitt D, Lee J, Bogen G. Multifaceted use of ProRoot MTA root canal repair material. Pediatr Dent 2001;23:326-30.  Back to cited text no. 4
    
5.
Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: A comprehensive literature review – Part III: Clinical applications, drawbacks, and mechanism of action. J Endod 2010;36:400-13.  Back to cited text no. 5
    
6.
Malkondu Ö, Karapinar Kazandağ M, Kazazoğlu E. A review on biodentine, a contemporary dentine replacement and repair material. Biomed Res Int 2014;2014:160951.  Back to cited text no. 6
    
7.
Farrokh Gisoure E. Comparison of three pulpotomy agents in primary molars: A randomised clinical trial. Iran Endod J 2011;6:11-4.  Back to cited text no. 7
    
8.
Lewis B. Formaldehyde in dentistry: A review for the millennium. J Clin Pediatr Dent 1998;22:167-77.  Back to cited text no. 8
    
9.
Noorollahian H. Comparison of mineral trioxide aggregate and formocresol as pulp medicaments for pulpotomies in primary molars. Br Dent J 2008;204:E20.  Back to cited text no. 9
    
10.
Simancas-Pallares MA, Díaz-Caballero AJ, Luna-Ricardo LM. Mineral trioxide aggregate in primary teeth pulpotomy. A systematic literature review. Med Oral Patol Oral Cir Bucal 2010;15:e942-6.  Back to cited text no. 10
    
11.
Koh ET, Pittford TR, Torabinejad M, McDonald F. Mineral trioxide aggregate stimulates cytokine production in human osteoblasts. J Bone Min Res 1995;10:406.  Back to cited text no. 11
    
12.
Laurent P, Camps J, About I. Biodentine (TM) induces TGF-β1 release from human pulp cells and early dental pulp mineralization. Int Endod J 2012;45:439-48.  Back to cited text no. 12
    
13.
Kusum B, Rakesh K, Richa K. Clinical and radiographical evaluation of mineral trioxide aggregate, biodentine and propolis as pulpotomy medicaments in primary teeth. Restor Dent Endod 2015;40:276-85.  Back to cited text no. 13
    
14.
Niranjani K, Prasad MG, Vasa AA, Divya G, Thakur MS, Saujanya K, et al. Clinical evaluation of success of primary teeth pulpotomy using mineral trioxide aggregate(®), laser and biodentine(TM) – An in vivo study. J Clin Diagn Res 2015;9:ZC35-7.  Back to cited text no. 14
    
15.
El Meligy OA, Allazzam S, Alamoudi NM. Comparison between biodentine and formocresol for pulpotomy of primary teeth: A randomized clinical trial. Quintessence Int 2016;47:571-80.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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  Introduction
  Case Report
  Discussion
  Conclusion
   References
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