Efficacy of orthoMTA, retroMTA and ferric sulphate as pulpotomy agents in primary molars: A randomized clinical trial

Purpose: The purpose of this study is to evaluate the clinical and radiographic success rates of RetroMTA, OrthoMTA, and ferric sulfate as pulpotomy agents in primary molars. Patients and Methods: Ninety-six primary second molars from 32 children aged 5 to 9 years were enrolled in this study. The teeth were randomly divided into three groups based on the pulpotomy agent used: O-MTA, R-MTA, and FS. Clinical and radiographic follow-up examinations were conducted at 3, 6, 9, and 18 months postoperatively. Results: At the end of the study period, 84 teeth were evaluated. The clinical success rates were 75% for FS, 96.4% for O-MTA, and 92.8% for R-MTA groups. In the radiographic analysis, the success rates at the 18-month follow-up period were 50% for FS, 85.8% for O-MTA, and 82.2% for R-MTA groups. According to the Chi-square test and Kaplan-Meier survival analysis, there was a statistically significant difference among the success rates and survival probabilities of the groups (p<0.05). Conclusion: OrthoMTA and RetroMTA demonstrated better treatment outcomes for pulpotomy of primary second molars than ferric sulfate at the 18-month follow-up period.

Keywords:

Pulpotomy, primary teeth, ferric sulphate mineral trioxide aggregate, zinc oxide eugenol cement,

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Coll JA, Seale NS, Vargas K, Marghalani AA, Al SS, Graham L. Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-analysis. Pediatr Dent 2017;39:16-123. google scholar
Asgary S, Shirvani A, Fazlyab M. MTA and Ferric Sulfate in Pulpotomy Outcomes of Primary Molars: A Systematic Review and Meta-Analysis. J Clin Pediatr Dent 2014;39: 1-8. google scholar
Ranly DM. Pulpotomy therapy in primary teeth: new modalities for old rationales. Pediatr Dent 1994; 16:403-9. google scholar
Agamy HA, Bakry NS, Mounir MMF, Avery DR. Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth. Pediatr Dent 2004;26:302-9. google scholar
Ibricevic H, al-Jame Q. Ferric sulfate as pulpotomy agent in primary teeth: twenty month clinical follow-up. J Clin Pediatr Dent 2000;24:269-72. google scholar
Lemon RR, Steele PJ, Jeansonne BG. Ferric sulfate hemostasis: Effect on osseous wound healing. I. Left in situ for maximum exposure. J Endod 1993;19:170-3. google scholar
Sonmez D, Sari S, Çetinbaş T. A Comparison of Four Pulpotomy Techniques in Primary google scholar
Silva LLCE, Cosme-Silva L, Sakai VT, Lopes CS, Silveira APPD, Moretti RN, Moretti ABD S. Comparison between calcium hydroxide mixtures and mineral trioxide aggregate in primary teeth pulpotomy: a randomized controlled trial. J Appl Oral Sci 2019;27:1-8. google scholar
Marghalani AA, Omar S, Chen JW. Clinical and radiographic success of mineral trioxide aggregate compared with formocresol as a pulpotomy treatment in primary molars: a systematic review and meta-analysis. J Am Dent Assoc 2014;145:714-21. google scholar
Junior ES, Vitcel MEB, Oliveira LB. Evidence of pulpotomy in primary teeth comparing MTA, calcium hydroxide, ferric sulphate, and electrosurgery with formocresol. Eur Arch Paediatr Dent 2015;16:303-12. google scholar
Kang CM, Kim SH, Shin Y, Lee HS, Lee JH, Kim GJ, Song JS. A randomized controlled trial of ProRoot MTA, OrthoMTA and RetroMTA for pulpotomy in primary molars. Oral Dis 2015;21:785–91. google scholar
Chang SW, Baek SH, Yang HC, Seo DG, Hong ST, Han SH, Lee Y, Gu Y, Kwon HB, Lee W, Bae KS, Kum KY. Heavy metal analysis of OrthoMTA and ProRoot MTA. J Endod 2011; 37:1673–6. google scholar
Kum KY, Zhu Q, Safavi K, Gu Y, Bae KS, Chang SW. Analysis of six heavy metals in Ortho mineral trioxide aggregate and ProRoot mineral trioxide aggregate by inductively coupled plasma-optical emission spectrometry. Aust Endod J 2013;39:126–30. google scholar
Souza LC, Yadlapati M, Dorn SO, Silva R, Letra A. Analysis of radiopacity, pH and cytotoxicity of a new bioceramic material. J Appl Oral Sci 2015;23:383–9. google scholar Goyal P, Pandit IK, Gugnani N, Gupta M, Goel R, Gambhir RS. Clinical and radiographic comparison of various medicaments used for pulpotomy in primary molars: A randomized clinical trial. Eur J Dent 2016;10:315. google scholar Fei AL, Udin RD, Johnson R. A clinical study of ferric sulfate as a pulpotomy agent in primary teeth. Pediatr Dent 1991;13:327–32. google scholar
Kopel HM. Considerations for the direct pulp capping procedure in primary teeth: a review of the literature. ASDC J Dent Child 1992; 59: 141-9. google scholar
Pinar A, Guven Y, Balli B, Ilhan B, Sepet E, Ulukapi I, et al. Success Rates of Mineral Trioxide Aggregate, Ferric Sulfate, and Formocresol Pulpotomies: A 24-month Study. Pediatr Dent J 2011; 33: 165–70. google scholar Havale R, Anegundi RT, Indushekar K, Sudha P. Clinical and radiographic evaluation of pulpotomies in primary molars with formocresol, glutaraldehyde and ferric sulphate. Oral Health Dent Manag 2013; 12: 24-31. google scholar
Fuks AB, Holan G, Davis JM, Eidelman E. Ferric sulfate versus dilute formocresol in pulpotomized primary molars: long-term follow up. Pediatr Dent 1997; 19: 327-30. google scholar
Moretti ABS, Sakai VT, Oliveira TM, Fornetti APC, Santos CFD, Machado MADAM, Abdo RCC. The effectiveness of mineral trioxide aggregate, calcium hydroxide and formocresol for pulpotomies in primary teeth. Int Endod J 2008 ;41 :547–55. google scholar
Peng L, Ye L, Tan H, Zhou X. Evaluation of the formocresol versus mineral trioxide aggregate primary molar pulpotomy: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: 40-4. google scholar
Cordell S, Kratunova E, Marion I, Alrayyes S, Alapati SB. A Randomized Controlled Trial Comparing the Success of Mineral Trioxide Aggregate and Ferric Sulfate as Pulpotomy Medicaments for Primary Molars. J Dent Child 2021; 88: 120-8. google scholar
Junqueira MA, Cunha NNO, Caixeta FF, Marques NCT, Oliveira TM, Moretti ABS, Cosme-Silva L, Sakai VT. Clinical, radiographic and histological evaluation of primary teeth pulpotomy using MTA and ferric sulfate. Braz Dent J 2018; 29: 159–65. google scholar
Patidar S, Kalra N, Khatri A, Tyagi R. Clinical and radiographic comparison of platelet-rich fibrin and mineral trioxide aggregate as pulpotomy agents in primary molars. J Indian Soc Pedod Prev Dent 2017; 35: 367. google scholar
Olatosi OO, Sote EO, Orenuga OO. Effect of mineral trioxide aggregate and formocresol pulpotomy on vital primary teeth: A clinical and radiographic study. Niger J Clin Pract 2015; 18 : 292-6. google scholar
Kusum B, Rakesh K, Richa K. Clinical and radiographic evaluation of mineral trioxide aggregate, biodentine and propolis as pulpotomy medicaments in primary teeth. Restor Dent Endod 2015; 40: 276-85. google scholar
Khedmat S, Aminipor M, Pourhajibagher M, Kharazifar MJ, Bahador A. Comparison of antibacterial activities of ProRoot MTA, OrthoMTA, and RetroMTA against three anaerobic endodontic bacteria. Journal of Dentistry 2018; 15: 294. google scholar
Sirohi K, Marwaha M, Gupta A, Bansal K, Srivastava A. Comparison of clinical and radiographic success rates of pulpotomy in primary molars using ferric sulfate and bioactive tricalcium silicate cement: an in vivo study. Int J Clin Pediatr Dent 2017;10:147. google scholar
Yildiz E, Tosun G. Evaluation of formocresol, calcium hydroxide, ferric sulfate, and MTA primary molar pulpotomies. Eur J Dent 2014; 8: 234-40. google scholar
Godhi B, Tyagi R. Success Rate of MTA Pulpotomy on Vital Pulp of Primary Molars: A 3-Year Observational Study. Int J Clin Pediatr Dent 2016; 9: 222–7. google scholar
Kim CH, Bae JS, Kim IH, Song JS, Choi HJ, Kang CM. Prognostic factors for the survival of primary molars following pulpotomy with mineral trioxide aggregate: a retrospective cohort study. Clin Oral Invest 2021; 25: 1797-804. google scholar
Lin YT, Lin YTJ. Success rates of mineral trioxide aggregate, ferric sulfate, and sodium hypochlorite pulpotomies: A prospective 24-month study. J Formos Med Assoc 2020; 119: 1080-5. google scholar
Eidelman E, Holan G, Fuks AB. Mineral trioxide aggregate vs. formocresol in pulpotomized primary molars: a preliminary report. Pediatr Dent 2001; 23: 15-8. google scholar
Farsi N, Alamoudi N, Balto K, Mushayt A. Success of mineral trioxide aggregate in pulpotomized primary molars. J Clin Pediatr Dent 2005; 29: 307-11. google scholar
Waterhouse PJ, Nunn JH, Whitworth JM, Soames JV. Primary molar pulp therapy–histological evaluation of failure. Int J Paediatr Dent 2000;10:313-21. google scholar
Holan G, Eidelman E, Fuks AB. Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol. Pediatr Dent 2005; 27: 129–36. google scholar
Holan G, Fuks A B, Ketlz N. Success rate of formocresol pulpotomy in primary molars restored with stainless steel crown vs amalgam. Pediatr Dent 2002; 24: 212–6. google scholar
Cuadros-Fernández C, Lorente Rodríguez AI, Sáez-Martínez S, García-Binimelis J, About I, Mercadé M. Short-term treatment outcome of pulpotomies in primary molars using mineral trioxide aggregate and Biodentine: a randomized clinical trial. Clin Oral Investig 2016; 20: 1639–45. google scholar
Kang CM, Sun Y, Song JS, Pang NS, Roh BD, Lee CY, Shin Y. A randomized controlled trial of various MTA materials for partial pulpotomy in permanent teeth. J Dent 2017; 60: 8-13. google scholar