Assessment of a novel alternative to conventional formocresol-zinc oxide eugenol pulpotomy for the treatment of pulpally involved human primary teeth: diode laser-mineral trioxide aggregate pulpotomy.
OBJECTIVE
The purpose of this study was to investigate whether a diode laser pulpotomy with mineral trioxide aggregate (MTA) sealing could be an acceptable alternative to the conventional formocresol pulpotomy and zinc oxide eugenol (ZOE) sealing in human primary teeth.


METHODS
A randomized, single-blind, split-mouth study was used with a sample of 16 children aged from 3 to 8 years (mean age=5.10 years). A total of 26 pairs of teeth from these 16 patients were selected based on clinical and radiographic criteria. One tooth from each pair was randomly assigned to either the laser-MTA pulpotomy group or the formocresol-ZOE pulpotomy group. All teeth were followed up clinically and radiographically at 2.3, 5.2, 9.5 and 15.7 months. All extracted failures were sectioned and photographed to assess possible reasons for this.


RESULTS
A total of seven laser-MTA-treated teeth were deemed to be radiographic failures (mean time until failure=9.1 months) compared to three formocresol-ZOE treated teeth (mean time until failure=12.5 months). These results were not significant using Fisher's exact test (P>0.05). Six of the laser-MTA failures and all three formocresol-ZOE failures exhibited furcal and/or periapical radiolucencies with or without pathologic root resorption. One of the laser-MTA failures displayed premature root resorption and is being observed for exfoliation. Analysis of photographs of teeth available for extraction revealed errors in clinical technique in addition to expected signs of a disease process such as the presence of granulation tissue and areas of pathologic root resorption.


CONCLUSIONS
The laser-MTA pulpotomy showed reduced radiographic success rates compared to the formocresol-ZOE pulpotomy at 15.7 months; however, these results were not statistically significant. Improved success rates among a larger patient sample and a longer follow-up period would be required for the laser-MTA pulpotomy to be considered a routine alternative to the conventional formocresol-ZOE procedure. Meticulous restorative techniques must be followed to ensure the success of laser-MTA pulpotomies.
Saltzman
B
B
Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, Ontario, Canada.
Sigal
M
M
Clokie
C
C
Rukavina
J
J
Titley
K
K
Kulkarni
G V
GV
D017607:Aluminum Compounds / Q000627:therapeutic use*; D017610:Calcium Compounds / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D019232:Dental Restoration Failure; D004338:Drug Combinations; D005260:Female; D005566:Formocresols / Q000627:therapeutic use; D017823:Furcation Defects / Q000000981:diagnostic imaging; D006801:Humans; D053685:Laser Therapy; D008297:Male; D010087:Oxides / Q000627:therapeutic use*; D011672:Pulpotomy / Q000379:methods*; D011859:Radiography; D012387:Root Canal Filling Materials / Q000627:therapeutic use*; D012391:Root Resorption / Q000000981:diagnostic imaging; D017640:Silicates / Q000627:therapeutic use*; D016037:Single-Blind Method; D014094:Tooth, Deciduous; D015035:Zinc Oxide-Eugenol Cement / Q000627:therapeutic use
D017607:Aluminum Compounds; D017610:Calcium Compounds; D004338:Drug Combinations; D005566:Formocresols; D010087:Oxides; D012387:Root Canal Filling Materials; D017640:Silicates; D015035:Zinc Oxide-Eugenol Cement; C086631:mineral trioxide aggregate; C031025:formocresol