Evaluation of Various Root Canal Filling Materials in Primary Molar Pulpectomies: An in Vivo Study

Howard E. Strassler, DMD

Ozalp N, Saroglu I, Sonmez H. Am J Dent. 2005;18(6): 347-350.

Abstract

Purpose: To evaluate the clinical and radiographic success of zinc oxide-eugenol (ZOE), Calcicur, Sealapex, and Vitapex in primary molar pulpectomies.  Methods: 80 primary molars, showing signs of pulpal and or periapical involvement, with no abnormal mobility, were selected from 76 children aged between 4-9 years-old, free from systemic disease. Radiographic evaluation was done to exclude teeth showing internal or pathological external root resorption and/or inadequate bone support. The selected teeth (20 in each group) were randomly treated with ZOE, Sealapex, Calcicur and Vitapex. The procedure involved primarily a one-visit pulpectomy. The teeth were evaluated clinically and radiographically every 2 months for a period of 18 months. Results: In the ZOE group, all pulpectomies were successful. In the Sealapex group, two pulpectomies and in the Calcicur group, four pulpectomies showed complete resorption of the material in the root canal. Although retreatment was performed, those teeth had to be removed due to pathological root resorption. In the Vitapex group, although six pulpectomies showed resorption of filling material in the canals, this had no effect on the clinical and radiographic success of the treatment.

COMMENTARY

In the past, it was easier for both the dentist and the parent to doom primary teeth to extraction when the pulp had a carious exposure. Treatment was unpredictable and there was the fear that the child would be in pain after direct pulp capping or pulpotomy. Dentists must educate parents on the importance of posterior primary teeth in the developing dentition and the use of endodontic treatment for posterior primary teeth. Premature loss of primary teeth, especially posterior teeth, continues to be an ongoing problem even though caries prevention continues to be an important part of treatment of the deciduous dentition. The implications of premature tooth loss include loss of function, compromised esthetics, changes occurring to arch length, and symmetry until normal exfoliation of these primary teeth. The use of root canal therapy for primary teeth has been contentious due to difficulty in behavior management of the child and complexity with root canal fillings for primary teeth. Root canal treatment of primary and permanent teeth have different criteria combined with the differences in pulpal anatomy in these teeth. This study provides the practitioner with insight in how using a pulpectomy and select medicaments, success in endodontic therapy to avoid premature loss of primary molars can be accomplished. While being successful, ZOE paste can sometimes be retained after tooth exfoliation. Calcium hydroxide pastes (Calcicur, Voco, Cuxhaven, Germany and Sealapex, SybronEndo, Orange, CA) and calcium hydroxide paste with iodoform (Vitapex®, Neo Dental International, Federal Way, WA) have been reported to have favorable success. Based upon this clinical research, Vitapex (Neo Dental) appears to be the closest to the ideal root canal filling material for primary teeth pulpectomies. Using this technique, the clinician can maintain primary molars until normal exfoliation.

About the Author

Howard E. Strassler, DMD Professor and Director of Operative Dentistry Department of Endodontics, Prosthodontics and Operative Dentistry University of Maryland Dental School, Baltimore, Maryland