Magister Scientiae Dentium - MSc(Dent) / Background: The primary goal of pulp therapy in the deciduous dentition is to keep the teeth fully functional in order to prevent arch space loss. A pulpectomy is a pulp therapy procedure indicated when an irreversibly inflamed or necrotic radicular pulp is encountered. ZOE and iodoform pastes (i.e. Kri 1 paste and Vitapex) have been recommended as root filling materials after pulpectomy. High clinical success rates have been reported with Vitapex and the fact that it resorbs readily when extruded beyond the apex is an added advantage. However, it has also been reported to resorb from within the root canals and even cause pathological root resorption in cases where the vital pulp is inflamed (Nurko et al., 2000). Iodoform-based preparations are thought to be more appropriate because they fulfill nearly all the requirements of the ideal root filling materials in primary teeth. Despite this, there are limited studies comparing the antibacterial effect of iodoform-based preparations. Aim: The aim of this study was to evaluate the antibacterial efficacy of Vitapex (V), Kri 1 paste (K) and pure iodoform (I) against E. faecalis.

Purpose: The purpose of this retrospective chart review was to determine if the survival of two methods of vital pulp therapy (VPT) were influenced by the pre-operative radiographic depth and location of caries. Methods: Electronic patient records (axiUm®) that contained the procedure codes D3120, Indirect Pulp Therapy (IPT), or D3220, Therapeutic Pulpotomy (TP), were queried. Qualifying charts’ pre-operative and post-operative radiographs were viewed in MiPACS® by two raters. Visit records were queried again to identify any other treatment failures. Results: A total of 568 primary molars met the eligibility criteria. There was a difference in survival depending upon the treatment procedure (P < .0001), with D3220 having a significantly higher failure rate than D3120. In the 182 total cases with caries 2/3 to encroaching the pulp, therapy success was greater with IPT (P < .0001). Conclusion: IPT results in longer overall clinical success even at the deepest level of caries.

Objectifs: Le but principal de cette étude prospective multicentrique est d’évaluer les succès clinique et radiographique des pulpotomies avec la Biodentine sur des dents permanentes traumatisées avec exposition pulpaire. Les objectifs secondaires sont d’évaluer si la maturation radiculaire affecte le pronostic du traitement et si la Biodentine cause une décoloration significative de la structure dentaire. Matériel et Méthode: Cette étude a été réalisée dans deux centres hospitaliers universitaires au Canada. Des sujets de moins de 18 ans se présentant avec un traumatisme sur les dents permanentes antérieures ont été invités à participer à cette étude. Les sujets médicalement compromis ainsi que les dents associées à une avulsion ont été exclus. La collecte de données comprenait: les données démographiques des patients, la durée et la taille de l'exposition pulpaire, le traumatisme associé et le stade de maturation radiculaire. Les cas ont été suivis jusqu’à 24 mois post-traitement. Les critères de succès clinique étaient l’absence de symptômes, des tests de vitalités positifs et un sondage normal. Le succès radiologique a été déterminé comme suit: continuation de la maturation radiculaire (apexogenèse) des dents immatures et apparence normale des tissus périradiculaires. Résultats: Quarante-cinq patients, dont 25 hommes et 20 femmes, âgés entre 8 et 16 ans (moyenne 10,86 ± 2,2) ont été inclus dans cette étude. Au total, 51 dents ont été traitées dont 29 dents immatures. Six dents traitées ont été perdues aux suivis et la période de suivi moyenne était de 13 mois (6-24). Les résultats ont montré un taux de survie de 100% et un taux de réussite de 91%. Quatre échecs ont été notés, deux à un mois et les deux autres à sept et 15 mois. Les résultats cliniques ont montré une diminution des symptômes et une augmentation de la positivité des tests de vitalité avec le temps. Huit dents ont présenté une légère décoloration, mais restaient esthétiquement acceptable. Les résultats radiologiques ont montré une formation de ponts dentinaires dans 90% des cas et toutes les dents immatures ont montré une continuation de la maturation radiculaire. Conclusions: Les pulpotomies à la Biodentine ont montré un taux de succès élevé sur des dents antérieures permanentes avec expositions pulpaires traumatiques avec un suivi moyen de 13 mois. Nos résultats montrent que la Biodentine peut constituer une alternative à l’hydroxyde de calcium et au Mineral Trioxide Aggregate et n’entraine pas une décoloration significative de la dent. Finalement, le stade de maturation radiculaire n’a pas affecté le pronostic du traitement. Mots-clés : Pulpotomie, thérapie pulpaire vitale, fracture coronaire avec exposition pulpaire, Biodentine. / Objectives: The aim of this multicentric prospective study was to evaluate the clinical and radiographic outcomes of Biodentine pulpotomies on permanent traumatised teeth with pulp exposure. The secondary objectives were to evaluate if root maturation affects the treatment outcome and to assess color stability of Biodentine. Methods: This study was carried out in two hospital-based dental departments in Canada. Children seeking emergency care following trauma to anterior permanent teeth were invited to participate in this study. Medically compromised children and teeth with concomitant avulsion were excluded. Data collected included: patient demographics, time since pulp exposure, size of exposure, associated trauma and radiographic root maturation stage. The treatment outcome was assessed clinically and radiographically up to 24 months after treatment. Clinical success was determined when a tooth remained asymptomatic and when it responded positively to vitality testing with normal probing. Radiographic success was determined as follow: continuation of root maturation (apexogenesis) in immature teeth and normal appearance of periradicular tissues. Results: Forty-five patients between the age of 8 to 16 years old (mean 10.86 ± 2.2) were included in this study. There were 25 males and 20 females. A total of 51 teeth were treated with a Biodentine pulpotomy of which twenty-nine (57%) had an immature apex. Six teeth were lost to follow-up. The average follow-up period was 13 months (6-24). This study showed a survival rate of 100% and a success rate of 91%. Four failures were noted, two at one month and the others at seven and 15 months post- treatment. Clinical outcomes showed that, over time, tooth sensitivity decreased whereas positive vitality testing increased. Eight teeth showed slight discoloration, however the results remained esthetically satisfying. Radiographic outcomes showed dentinal bridge formation in 90% of cases. All immature teeth showed continued root formation. Conclusions: Biodentine pulpotomies showed a high success rate on anterior permanent traumatized teeth with a pulp exposure at 13 months follow-up. According to our results, Biodentine may be a good alternative to calcium hydroxide and Mineral Trioxide Aggregate vital pulpotomies and did not cause significant discoloration. Finally, root maturation did not affect the treatment outcome. Keywords: Complicated crown fractures, pulpotomy, vital pulp therapy, Biodentine.