ZOE Paste Pulpectomies Outcome in Primary Teeth: A Systematic Review

School of Dentistry, Federal Fluminense University (UFF), Pólo Universitário de Nova Friburgo (PUNF), Rio de Janeiro, Brazil.
The Journal of clinical pediatric dentistry (Impact Factor: 0.35). 04/2011; 35(3):241-8. DOI: 10.17796/jcpd.35.3.y777187463255n34
Source: PubMed


To perform a systematic review in which the clinical research question for primary teeth with irreversible pulpal pathosis was "how pulpectomies with zinc oxide eugenol (ZOE) paste performed compared to other materials in their clinical and radiographic outcomes after twelve months or more follow-up period.
A literature survey of the electronic database (1950-2010) used the Medical Subject Headings and free text terms. Forty three references were retrieved and inclusion criteria were applied; 15 articles remained for full-text evaluation. From these, two were selected for data extraction regarding quality characteristics and results.
Selected studies showed moderate or high risk of bias. The overall success of pulpectomy was 80.0% (Calcicur), 60.0% (Sealapex) and varied from 85.0% to 100.0% (ZOE) and 89.0% to 100.0% (Vitapex). Solely Calcicur presented success rate significantly lower when compared to ZOE and Vitapex. These pastes lead to overfilled canals and particles of extruded ZOE were still evident even after the evaluation period. Resorption of Vitapex, Calcicur and Sealapex within the root canal was also reported.
In primary teeth with irreversible pulpal changes ZOE pulpectomies yielded similar outcome than Vitapex and Sealapex, although there was no agreement with regard to filling materials' resorption.

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Available from: Lucianne Cople Maia, Jan 28, 2014
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    • "The filling material must be effective in eliminating or reducing bacteria, as well as preventing canal reinfection, and must be resorbable and nontoxic to periapical tissues and the permanent tooth germ (Huang et al. 2009, Silva et al. 2010). Currently, there is a growing preference for using iodoform paste and calcium hydroxide paste (Dunston & Coll 2008, Bergoli et al. 2010), instead of zinc oxide eugenol paste (Barcelos et al. 2011), probably because of its irritant potential to periapical tissues and slow resorption rate (Silva et al. 2010). Calcium hydroxide pastes are antimicrobial, owing to their high pH and release of hydroxyl and calcium ions (Estrela et al. 1995). "
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    ABSTRACT: Aim: To evaluate the cytotoxicity, oxidative stress and genotoxicity in vitro of four iodoform pastes and three calcium hydroxide pastes. Methodology: Peripheral blood mononuclear cells (PBMCs) and pure calf thymus DNA (dsDNA) were exposed to extracts of the pastes. Cytotoxicity was assessed with the MTT assay. Generation of reactive oxygen species (ROS) was evaluated using a DCFH-DA assay, and lipid peroxidation was evaluated using a TBARS assay. Genotoxicity was evaluated using the alkaline comet assay and Genomodifier capacity assay (GEMO). All tests were performed after 24 h and 72 h of cell exposure, except GEMO. After performing the Kolmogorov-Smirnov test, data were analysed by Kruskal-Wallis and Dunn's post-tests, and anova with Dunnett's post-test, with a significance level established at P < 0.05. Results: The MTT assay revealed that chlorhexidine, Maxitrol and neomycin sulphate + bacitracin pastes decreased cell viability after 24 h (P < 0.05). No group was associated with a significant decreased cell viability or lipid peroxidation after 72 h. Calcium hydroxide pastes increased the cell viability levels at both experimental times (P < 0.05). Lipid peroxidation was observed with the exposure of cells to calcium hydroxide pastes after 24 h (P < 0.05). Exposure to chlorhexidine, Guedes-Pinto and calcium hydroxide pastes resulted in a significant increase in ROS after 24 h (P < 0.05), whereas iodoform pastes and Calen thickened with zinc oxide significantly increased the ROS after 72 h (P < 0.05). The comet assay revealed that exposure of the PBMCs to iodoform pastes did not damage DNA at either period of time (P > 0.05). However, chlorhexidine paste caused DNA damage in dsDNA (P < 0.05). Calcium hydroxide pastes caused DNA damage in both tests (P < 0.05). Conclusion: The pastes varied in their ability to induce cytotoxicity, genotoxicity and oxidative stress. In general, Guedes-Pinto, Maxitrol and neomycin sulphate + bacitracin pastes exhibited better biocompatibility in vitro.
    Full-text · Article · Jul 2015 · International Endodontic Journal
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    ABSTRACT: Many materials have been used for pulp treatment in primary teeth, but not many of them are extensively supported in the dental literature. In recent years, new materials have been introduced along with new procedures, and these will be reviewed in this article. Many of these new materials have shown promising results in the short run but can only be thoroughly evaluated after longer use and more extensive applications. There is clearly a need for long‐term studies to identify the best materials for pulp treatment of primary teeth.
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    ABSTRACT: 4 Objetivo: Avaliar a eficácia de pulpectomias com remoção de smear layer em dentes decíduos anteriores e as condições clínicas dos sucessores permanentes após cinco anos de acompanhamento clínico e radiográfico. Método: Foram selecionadas crianças com idade entre três a cinco anos, clinicamente saudáveis, com necessidade de tratamento do canal radicular em dentes anteriores decorrente de cárie e/ou traumatismo dento-alveolar. O preparo químico-mecânico consistiu da instrumentação com limas K e hipoclorito de sódio 1,0% e na irrigação final, o ácido cítrico a 6,0% foi utilizado para remoção da smear layer. Os condutos foram obturados com o cimento de OZE e todos os dentes restaurados com compósito fotopolimerizável. A avaliação clínica e/ou radiográfica ocorreu no primeiro mês e sucessivamente durante seis meses até cinco anos pós-tratamento ou até a erupção do sucessor permanente. Resultados: O índice de sucesso observado foi de 91,5%. Após cinco anos de acompanhamento, trinta e oito dentes permanentes sucessores (80,9%) estavam erupcionados. Destes, cinco (10,6%) elementos apresentaram erupção ectópica e cinco (10,6%) apresentaram opacidades no esmalte. Não foi observada associação entre o desfecho do tratamento (sucesso ou insucesso) e determinadas variáveis observadas, como o motivo da alteração pulpar, diagnóstico pulpar, presença de lesão periapical e extensão da obturação. Conclusão: Após cinco anos de acompanhamento, as pulpectomias de dentes decíduos anteriores com remoção de smear layer apresentaram alto índice de sucesso sugerindo que o uso do ácido cítrico favoreceu o desempenho da terapia. Foi observado um número reduzido de opacidades do esmalte e de erupção ectópica nos permanentes sucessores. A partir dos resultados observados, recomenda-se a realização de novos estudos clínicos, preferencialmente controlados e randomizados, utilizando o mesmo protocolo e incluindo molares, a fim de comprovar a efetividade da remoção de smear layer nas pulpectomias de dentes decíduos. Pulpectomia; Dente decíduo; Lama dentinária; Ácido cítrico. Objective: To evaluate the efficacy de pulpectomies with removal of smear layer in primary anterior teeth and the clinical conditions of the permanent successors after five years of clinical and radiographic follow up. Method: Clinically healthy children aged 3 to 5 years requiring root canal treatment in anterior teeth due to caries and/or dentoalveolar trauma were selected. The chemomechanical preparation consisted of instrumentation with K files and 1.0% sodium hypochlorite and final irrigation with 6.0% citric acid for removal of smear layer. The canals were filled with ZOE and all teeth were restored with photoactivated composite resin. Clinical and/or radiographic evaluation was carried out in the first month and then successively during six months up to five years posttreatment or up to eruption of the permanent successor. Results: The success rate was 91.5%. After five years of follow up, 38 permanent successors (80.9%) had erupted. From these, 5 (10.6%) teeth erupted ectopically and five (10.6%) presented enamel opacities. There was no association between treatment outcome (success or failure) and certain factors, such as pulpal alteration, pulpal diagnosis, presence of periapical lesion and apical limit of obturation. Conclusion: After five years of follow up, the pulpectomies in primary anterior teeth with removal of smear layer presented a high success rate, suggesting that the use of citric acid was favorable to the therapy. There was a small number of enamel opacities and ectopic eruptions of the permanent successors. Based on the obtained results, it is recommended the development of new clinical studies, especially controlled and randomized trials, using the same protocol and including molars, in order to confirm the effectiveness of smear layer removal in the pulpectomies of primary teeth.
    Full-text · Article · Apr 2011 · Pesquisa Brasileira em Odontopediatria e Clínica Integrada
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