Calcium hydroxide effective for partial pulpectomy in primary molars

anatomy of teeth

Pulpotomy  is one of a number of approaches (indirect pulp capping, direct pulp capping, pulpotomy, pulpectomy) for managing carious lesions approaching the pulp of primary teeth with the aim of retaining  the tooth in a symptom free state until it is lost naturally thus avoiding an extraction.  Formocresol has been used for a number of years  but issues have been raised regarding its toxicity.  The aim of this trial was to compare the effectiveness of  Calcium hydroxide [Ca(OH)2] partial pulpectomy  (PP)  against  formocresol pulpotomy (FP) for the treatment of treatment of pulpally exposed lower primary molars.

Patient attending a paediatric dental department were randomised to  randomly assigned to  PP or FP treatment.  All teeth were treated under local anaesthesia and rubber dam. Clinical and radiographic evaluations at six-monthly intervals  were conducted by a masked investigator.

86 lower primary molars from 58 children were treated and they found:-

  •  The success rates for the two treatments at each 6-month interval were not different (P ‡ 0.05).

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  • The most frequent failure was internal resorption, affecting five FP teeth and three PP teeth.

The authors concluded

 Considering the favourable clinical and radiographic success rate of PP and the potentially toxic effects of formocresol leads us to recommend the use of PP instead of FP in primary teeth with deep carious lesions.

Related reviews  and guidelines

Scottish Dental Clinical Effectiveness Programme (SDCEP) . Prevention and Management of Dental Caries in Children.  Chapter 9. pages 54-57.  2010

American Academy of Pediatric Dentistry (AAPD). Guideline on pulp therapy for primary and immature permanent teeth. Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2009. 8 p. [107 references]

Nadin G, Goel BR, Yeung A, Glenny AM. Pulp treatment for extensive decay in primary teeth. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003220. DOI: 10.1002/14651858.CD003220.


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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