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Prognostic factors for the survival of primary molars following pulpotomy with mineral trioxide aggregate: a retrospective cohort study

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Abstract

Objectives

The aim of the present study was to evaluate potential factors influencing the success rates of mineral trioxide aggregate (MTA) pulpotomy performed in primary molars.

Materials and methods

A total of 347 teeth treated between March 2012 and December 2016 in 258 patients, with a mean age of 5.3 ± 1.7 years, were included in the analysis. Kaplan-Meier analyses were used to analyze were used time to failure. Multivariate Cox regression analysis with shared frailty was used to evaluate the clinical factors associated with failures.

Results

The mean (standard deviation) follow-up period was 35.8 (19.6) months. Within 84 months, the survival rate was 87.1%. In multivariate Cox regression, treatment performed in lower primary molars had a lower survival rate than upper primary molars (hazard ratio [HR] = 3.38, P = 0.012). Caries extension below the cemento-enamel junction had more risk of failure (HR = 10.9, P < 0.001). Final restoration using resin-modified glass ionomer or amalgam (direct filling) had a lower survival rate than stainless steel crown (HR = 5.62, P = 0.002).

Conclusions

Clinical variables such as arch type, degree of caries extension, and type of final restoration may affect the survival of primary molars following MTA pulpotomy.

Clinical relevance

The results of this study indicate that specific clinical variables can be used to predict the prognosis of MTA pulpotomy in primary teeth, and estimate the risk of treatment failure. Assessments of these variables should be performed in the context of evidence-based clinical decision making.

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References

  1. Fuks AB, Kupietzky A, Guelmann M (2019) Pulp therapy for the primary dentition. In: Nowak AJ, Christensen JR, Mabry TR, Townsend JA, Wells MH (eds) Pediatric dentistry: infancy through adolescence, 6th edn. Elsevier, Philadelphia, pp 329–351. https://doi.org/10.1016/B978-0-323-60826-8.00023-7

    Chapter  Google Scholar 

  2. Fuks AB (2002) Current concepts in vital primary pulp therapy. Eur J Paediatr Dent 3(3):115–120

    PubMed  Google Scholar 

  3. Tziafas D (2004) The future role of a molecular approach to pulp-dentinal regeneration. Caries Res 38(3):314–320. https://doi.org/10.1159/000077771

    Article  PubMed  Google Scholar 

  4. Smail-Faugeron V, Glenny AM, Courson F, Durieux P, Muller-Bolla M, Fron Chabouis H (2018) Pulp treatment for extensive decay in primary teeth. Cochrane Database Syst Rev 5(5):CD003220. https://doi.org/10.1002/14651858.CD003220.pub3

    Article  PubMed  Google Scholar 

  5. Sun HW, Feigal RJ, Messer HH (1990) Cytotoxicity of glutaraldehyde and formaldehyde in relation to time of exposure and concentration. Pediatr Dent 12(5):303–307

    PubMed  Google Scholar 

  6. Srinivasan V, Patchett CL, Waterhouse PJ (2006) Is there life after Buckley’s Formocresol? Part I--a narrative review of alternative interventions and materials. Int J Paediatr Dent 16(2):117–127. https://doi.org/10.1111/j.1365-263X.2006.00688.x

    Article  PubMed  Google Scholar 

  7. Fuks AB (2008) Vital pulp therapy with new materials for primary teeth: new directions and treatment perspectives. J Endod 34(7):18–24. https://doi.org/10.1016/j.joen.2008.02.031

    Article  Google Scholar 

  8. Schröder U (1978) A 2-year follow-up of primary molars, pulpotomized with a gentle technique and capped with calcium hydroxide. Scand J Dent Res 86(4):273–278. https://doi.org/10.1111/j.1600-0722.1978.tb00628.x

    Article  PubMed  Google Scholar 

  9. Waterhouse PJ (1995) Formocresol and alternative primary molar pulpotomy medicaments: a review. Endod Dent Traumatol 11(4):157–162. https://doi.org/10.1111/j.1600-9657.1995.tb00479.x

    Article  PubMed  Google Scholar 

  10. Waterhouse PJ, Nunn JH, Whitworth JM (2000) An investigation of the relative efficacy of Buckley’s formocresol and calcium hydroxide in primary molar vital pulp therapy. Br Dent J 188(1):32–36. https://doi.org/10.1038/sj.bdj.4800380

    Article  PubMed  Google Scholar 

  11. Mitchell PJ, Pitt Ford TR, Torabinejad M, McDonald F (1999) Osteoblast biocompatibility of mineral trioxide aggregate. Biomaterials 20(2):167–173

    Article  Google Scholar 

  12. Kang JY, Kim JS, Yoo SH (2011) Comparison of setting expansion and time of orthoMTA, proroot MTA and Portland cement (comparison of setting expansion and time of orthomta, proroot mta and Portland cement). J Korean Acad Pediatr Dent 38(3):229–236

    Google Scholar 

  13. Ferreira DC, Brito DG, Cavalcanti BN (2009) Cytokine production from human primary teeth pulp fibroblasts stimulated by different pulpotomy agents. J Dent Child (Chic) 76(3):194–198

    Google Scholar 

  14. Torabinejad M, Chivian N (1999) Clinical applications of mineral trioxide aggregate. J Endod 25(3):197–205. https://doi.org/10.1016/S0099-2399(99)80142-3

    Article  PubMed  Google Scholar 

  15. Agamy HA, Bakry NS, Mounir MMF, Avery DR (2004) Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth. Pediatr Dent 26(4):302–309

    PubMed  Google Scholar 

  16. Ng FK, Messer LB (2008) Mineral trioxide aggregate as a pulpotomy medicament: a narrative review. Eur Arch Paediatr Dent 9(1):4–11. https://doi.org/10.1007/BF03321589

    Article  PubMed  Google Scholar 

  17. Cardoso-Silva C, Barberia E, Maroto M, Garcia-Godoy F (2011) Clinical study of mineral trioxide aggregate in primary molars. comparison between grey and white MTA--a long term follow-up (84 months). J Dent 39(2):187–193. https://doi.org/10.1016/j.jdent.2010.11.010

    Article  PubMed  Google Scholar 

  18. Holan G, Eidelman E, Fuks AB (2005) Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol. Pediatr Dent 27(2):129–136

    PubMed  Google Scholar 

  19. Liu H, Zhou Q, Qin M (2011) Mineral trioxide aggregate versus calcium hydroxide for pulpotomy in primary molars. Chin J Dent Res 14(2):121–125

    PubMed  Google Scholar 

  20. Celik B, Atac AS, Cehreli ZC, Uysal S (2013) A randomized trial of mineral trioxide aggregate cements in primary tooth pulpotomies. J Dent Child (Chic) 80(3):126–132

    Google Scholar 

  21. Yildiz E, Tosun G (2014) Evaluation of formocresol, calcium hydroxide, ferric sulfate, and MTA primary molar pulpotomies. Eur J Dent 8(2):234–240. https://doi.org/10.4103/1305-7456.130616

    Article  PubMed  PubMed Central  Google Scholar 

  22. Musale PK, Soni AS (2016) Clinical Pulpotomy trial of Copaifera langsdorffii oil resin versus formocresol and white mineral trioxide aggregate in primary teeth. Pediatr Dent 38(2):5–12

    PubMed  Google Scholar 

  23. Kang CM, Kim SH, Shin Y, Lee HS, Lee JH, Kim GT, Song JS (2015) A randomized controlled trial of ProRoot MTA, OrthoMTA and RetroMTA for pulpotomy in primary molars. Oral Dis 21(6):785–791. https://doi.org/10.1111/odi.12348

    Article  PubMed  Google Scholar 

  24. Shirvani A, Asgary S (2014) Mineral trioxide aggregate versus formocresol pulpotomy: a systematic review and meta-analysis of randomized clinical trials. Clin Oral Investig 18(4):1023–1030. https://doi.org/10.1007/s00784-014-1189-2

    Article  PubMed  Google Scholar 

  25. Farsi N, Alamoudi N, Balto K, Mushayt A (2005) Success of mineral trioxide aggregate in pulpotomized primary molars. J Clin Pediatr Dent 29(4):307–311. https://doi.org/10.17796/jcpd.29.4.n80t77w625118k73

    Article  PubMed  Google Scholar 

  26. Stringhini Junior E, Vitcel ME, Oliveira LB (2015) Evidence of pulpotomy in primary teeth comparing MTA, calcium hydroxide, ferric sulphate, and electrosurgery with formocresol. Eur Arch Paediatr Dent 16(4):303–312. https://doi.org/10.1007/s40368-015-0174-z

    Article  PubMed  Google Scholar 

  27. Dhar V, Marghalani AA, Crystal YO, Kumar A, Ritwik P, Tulunoglu O, Graham L (2017) Use of vital pulp therapies in primary teeth with deep caries lesions. Pediatr Dent 39(5):146–159

    PubMed  Google Scholar 

  28. Anthonappa RP, King NM, Martens LC (2013) Is there sufficient evidence to support the long-term efficacy of mineral trioxide aggregate (MTA) for endodontic therapy in primary teeth? Int Endod J 46(3):198–204. https://doi.org/10.1111/j.1365-2591.2012.02128.x

    Article  PubMed  Google Scholar 

  29. Lin PY, Chen HS, Wang YH, Tu YK (2014) Primary molar pulpotomy: a systematic review and network meta-analysis. J Dent 42(9):1060–1077. https://doi.org/10.1016/j.jdent.2014.02.001

    Article  PubMed  Google Scholar 

  30. (2018) Pulp therapy for primary and immature permanent teeth. Pediatr Dent 40(6):343–351

  31. Pedrotti D, Ribeiro JF, Weber Pires C, de Oliveira RR, Ardenghi TM, Soares FZM, Lenzi TL (2017) Survival and associated risk factors of resin-based composite restorations in primary teeth: a clinical, retrospective, university-based study. Pediatr Dent 39(4):313–318

    PubMed  Google Scholar 

  32. Campagna P, Pinto LT, Lenzi TL, Ardenghi TM, de Oliveira RR, Oliveira MDM (2018) Survival and associated risk factors of composite restorations in children with early childhood caries: a clinical retrospective study. Pediatr Dent 40(3):210–214

    PubMed  Google Scholar 

  33. Strange DM, Seale NS, Nunn ME, Strange M (2001) Outcome of formocresol/ZOE sub-base pulpotomies utilizing alternative radiographic success criteria. Pediatr Dent 23(4):331–336

    PubMed  Google Scholar 

  34. Ward J (2002) Vital pulp therapy in cariously exposed permanent teeth and its limitations. Aust Endod J 28(1):29–37. https://doi.org/10.1111/j.1747-4477.2002.tb00364.x

    Article  PubMed  Google Scholar 

  35. Awawdeh L, Al-Qudah A, Hamouri H, Chakra RJ (2018) Outcomes of vital pulp therapy using mineral trioxide aggregate or biodentine: a prospective randomized clinical trial. J Endod 44(11):1603–1609. https://doi.org/10.1016/j.joen.2018.08.004

    Article  PubMed  Google Scholar 

  36. Olmez A, Tuna D, Ozdogan YT, Ulker AE (2008) The effectiveness of different thickness of mineral trioxide aggregate on coronal leakage in endodontically treated deciduous teeth. J Dent Child (Chic) 75(3):260–263

    Google Scholar 

  37. Gross EL, Nowak AJ (2019) The dynamics of change. In: Nowak AJ, Christensen JR, Mabry TR, Townsend JA, Wells MH (eds) Pediatric dentistry: infancy through adolescence, vol 6th. Elsevier, Philadelphia, pp 260–264. https://doi.org/10.1016/B978-0-323-60826-8.00018-3

    Chapter  Google Scholar 

  38. Seale NS, Randall R (2015) The use of stainless steel crowns: a systematic literature review. Pediatr Dent 37(2):147–162

    Google Scholar 

  39. Al-Zayer MA, Straffon LH, Feigal RJ, Welch KB (2003) Indirect pulp treatment of primary posterior teeth: a retrospective study. Pediatr Dent 25(1):29–36

    PubMed  Google Scholar 

  40. Guelmann M, Fair J, Bimstein E (2005) Permanent versus temporary restorations after emergency pulpotomies in primary molars. Pediatr Dent 27(6):478–481

    PubMed  Google Scholar 

  41. Hutcheson C, Seale NS, McWhorter A, Kerins C, Wright J (2012) Multi-surface composite vs stainless steel crown restorations after mineral trioxide aggregate pulpotomy: a randomized controlled trial. Pediatr Dent 34(7):460–467

    PubMed  Google Scholar 

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Funding

This study was supported by the Yonsei University College of Dentistry Fund (2020-32-0013)

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Author notes

  1. Chi Hoon Kim and Jee Soo Bae contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Dentistry, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul, 03722, Republic of Korea

    Chi Hoon Kim, Jee Soo Bae, Ik-Hwan Kim, Je Seon Song, Hyung-Jun Choi & Chung-Min Kang

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  1. Chi Hoon Kim
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Correspondence to Chung-Min Kang.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board (approval no. IRB 2-2019-0043) at Yonsei University Dental Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Kim, C.H., Bae, J.S., Kim, IH. et al. Prognostic factors for the survival of primary molars following pulpotomy with mineral trioxide aggregate: a retrospective cohort study. Clin Oral Invest 25, 1797–1804 (2021). https://doi.org/10.1007/s00784-020-03482-3

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