Success rate of MedCem Portland Cement as pulp capping agent in - - PowerPoint PPT Presentation

V.Vilimek, B.Christof

Success rate of MedCem Portland Cement as pulp capping agent in pulpotomy in the primary dentition V.Vilimek, B.Christof

Private practice for pediatric and family dentistry Hohenems – Austria

Is the treatment of choice in cases (AAPD 2012-2013):

• Reversible pulpits
• When caries removal results in pulp exposure
• After traumatic exposure

Pulpotomy in primary dentition

V.Vilimek, B.Christof

Pulpotomy in primary dentition

The success of the therapy depends on:

• Correct diagnosis of the inflamed dental pulp.
• Selection of biocompatible and bio-inductive material
• Recently, great interest has been focused on the evolution of

Portland cement (PC) as an alternative to MTA.

V.Vilimek, B.Christof

AIM:

• To evaluate the clinical and radiographic outcomes of

Portland cement (PC) as pulp capping agent in primary teeth pulpotomies.

Pulpotomy in primary dentition

V.Vilimek, B.Christof

V.Vilimek, B.Christof

The study included:

• 71 primary teeth (9 incisors and 62 molars)
• f 20 girls and boys (ASA 1) aged 3-8 years
• With deep carious lesions:
• Presenting a potential risk of pulp exposure during treatment.
• With symptoms of inflammation of the coronal pulp.

Material and Methods:

V.Vilimek, B.Christof

Excluded from the study:

• Clinical criteria:
• Spontaneous pain.
• Mobility.
• Fistula.
• Abscess (gingival redness

and swelling).

• Systemic diseases.

Material and Methods:

• Radiographic criteria:
• Teeth with more than 2/3 root

resorption.

• Periodontal ligament widening.
• Periodontal and furcation bone

resorption

V.Vilimek, B.Christof

METHODS: Pulpotomy in primary dentition

Treatment was performed under general anesthesia and with the technique of vital amputation.

V.Vilimek, B.Christof

METHODS: Pulpotomy in primary dentition

The teeth were finally restored:

• Incisors with composite
• Molars with stainless steel crowns.

The pulp chamber was opened with a high-speed, water cooled diamond bur. Followed by removal of the entire coronal pulp with a low speed, round carbide bur. The pulp chamber was rinsed with a sterile saline. Sterile cotton pellets were applied to the pulp chamber for 2 min to control hemorrhage upon successful hemostasis. MedCem Portland Cement (PC) was used as pulp capping agent. Over the PC GIC ( Ketac Cem radio pac) was placed.

Follow up:

V.Vilimek, B.Christof

• Clinical and radiographic successes and failures were

recorded at 3, 6, 12, 18 and 24-month follow-up.

• Radiographic success was

considered:

• Presence of hard tissue barrier

formation (HTB).

• Pulp calcifications (PC).
• Absence of internal or external

root resorption (R).

• Furcation radiolucency (FRL).

Follow up:

V.Vilimek, B.Christof

• Clinical and radiographic successes and failures were

recorded at 3, 6, 12, 18 and 24-month follow-up.

• Criteria to determine failure:
• Spontaneous pain (SP).
• Swelling (Sw).
• Abscess (gingival redness and

swelling).

• Sensitivity to percussion.
• Mobility (M).
• Fistula (F).
• Periodontal ligament widening.
• Periodical and furcation bone

resorption (RR).

Results:

V.Vilimek, B.Christof

N* Mth Clinical criteria x-Ray criteria Total SP M, Sw , F R HTB PC RR FRL S* F* N = 3 mth 1 Sw, F 70 1 N= 6 mth 1 69 2 N= 12 mth N= 18 mth 1 – Sw 1 - F 67 4 N= 24 mth 1 66 5

*N – number of teeth, *S – success, *F – failure

SW = Swelling F= Fistula Furcation radiolucency = FRL Periodical and furcation bone resorption = RR

Results:

V.Vilimek, B.Christof

Meas ure S rate 95% CI LB 95% CI UB Group S rate diff test - p

3m 98.59% 92.40% 99.97% 6m 97.18% 90.19% 99.66% 12m 97.18% 90.19% 99.66% 18m 94.37% 86.19% 98.45% 24m 92.96% 84.31% 97.68% > 0.05

(р>0,05)

3 m 24 m 12 m

Results

After 3 months the treatment of 70 teeth or 98.59% was assessed as successful. The confidence level is between 92.4 % to 99.97% - After 12 months 69 teeth (97.18 % ) were assessed as successfully treated. After 24 months the treatment of 66 teeth (92.96%) was defined as successful. The difference between the treatment in the beginning 98.59% and in the end 92.96% is statistically not significant. That means the success of 92.96 % after 24 months does not differ to the success after 3 months 98.59%. As to be seen our result showed the success rate of pulpotomies using Mec Cem Portland Cement as pulp agent in primary dentition during the

• bservation period of a 2 years follow up.

Results after pulpotomy with PC

Before Treatment After 12 months After 24 months 51 after 6 Months of treatment crowns were replaced After 18 months

Successful treatment even after 24 months !

Results after pulpotomy with PC

• Failure after 12 months of treatment

tooth 75 showed up internal resorption, no fistula, no abscess, no pain

• Failure after 24 months of treatment

tooth 75 showed up full root resorption and tooth 74 a crown lost and root resorption

Before Treatment After 12 months After 24 months

Pulpotomy in primary dentition

V.Vilimek, B.Christof

CONCLUSION:

• Portland Cement may serve as an effective and

inexpensive material in primary teeth pulpotomies.

• Further studies and longer follow-up assessments are

needed.

Pulpotomy in primary dentition

V.Vilimek, B.Christof

CONCLUSION: According to the achieved results, we recommend Portland Cement Med Cem as a successful pulp agent