Comparative evaluation of the efficacy of chitosan and formocresol as medicaments for pulpotomy in primary molars: A clinical pilot study

Nihal R Kothari1Orcid, S K Srinath2Orcid, Sulakshana S3Orcid, Aswathy T4Orcid, Padmapriya S5Orcid

Highlights

This study evaluated the efficacy of chitosan which is a non toxic, bioactive material with anti microbial and wound healing properties as pulpotomy medicaments in primary teeth.
While both groups showed similar success rate clinically, chitosan had better success rate radiographically.
Chitosan is a safe, biocompatible and effective medicament for pulpotomy in primary molars. Owing to its advantages of chitosan, it can be used as an alternative to formocresol as a pulpotomy agent.

Abstract

Aim: To compare the clinical and radiographic effectiveness of chitosan and formocresol as pulpotomy medicaments in primary molars. Methods: Children of age 4-8 years old, who were physically and mentally healthy without any known medical history of systemic conditions contraindicating pulp therapy with at least one deep carious primary molars indicated for pulpotomy, were recruited. Pulpotomies were performed on 64 teeth divided into 2 groups, Group A (chitosan) and Group B (formocresol), followed by stainless steel crowns. Evaluation of clinical and radiological success was done at 1, 3 and 6 months follow up. Chi Square Test was used to compare the clinical and radiological parameters between study groups at different time intervals (p < 0.05) Results: Clinical success rate in both groups was 96.6% and radiographic success rate in chitosan was 96.6%, but formocresol was 89.6%. Conclusions: Chitosan was found to be an effective medicament for pulpotomy in primary molars. While chitosan also showed improved success rate compared to formocresol, it was not statistically significant.

Keywords: Chitosan; Formocresol; Pulpotomy

Author Affiliations

  1. Post graduate, Department of Pedodontics, Government Dental College And Research Institute, Bengaluru-560002(✉ Correspondence: nihalkothari44@gmail.com)
  2. Professor and Head, Department of Pedodontics, Government Dental College And Research Institute, Bengaluru-560002
  3. Assistant Professor, Department of Pedodontics, Government Dental College And Research Institute, Bengaluru-560002
  4. Post graduate, Department of Pedodontics, Government Dental College And Research Institute, Bengaluru-560002
  5. Post graduate, Department of Pedodontics, Government Dental College And Research Institute, Bengaluru-560002
  1. Parisay I, Ghoddusi J, Forghani M. A review on vital pulp therapy in primary teeth. Iran Endod J 2015;10:6-15
  2. AAPD Reference Manual. Pulp therapy for primary and immature permanent teeth. Pediatr Dent 2020:21;384-392
  3. Duggal MS, Nooh A, High A. Response of the primary pulp to inflammation: a review of the Leeds studies and challenges for the future. Eur J Paediatr Dent 2002; 3:111-114
  4. Camp JH, Fuks AB. Pediatric endodontics. In: Hargreaves KM, Berman LH, editors. Cohen’s Pathways of the pulp. 10th ed. USA: Elsevier; 2011.p. 808-857
  5. Fuks AB. Current concepts in vital primary pulp therapy. Eur J Paediatr Dent 2002;3:115–120
  6. Coll JA, Seale NS, Vargas K, Marghalani AA, Al Shamali S, Graham L. Primary tooth vital pulp therapy: A systematic review and meta-analysis. Pediatr Dent 2017;39:116-123
  7. Sushynski JM, Zealand CM, Botero TM, Boynton JR, Majewski RF, Shelburne CE et al. Comparison of gray mineral trioxide aggregate and diluted formocresol in pulpotomized primary molars: a 6- to 24-month observation. Pediatr Dent 2012;34:120-128
  8. Hugar SM, Kukreja P, Hugar SS, Gokhale N, Assudani H. Comparative evaluation of clinical and radiographic success of formocresol, propolis, turmeric gel, and calcium hydroxide on pulpotomized primary molars: A preliminary study. Int J Clin Pediatr Dent 2017;10:18-23
  9. Pashley EL, Myers DR, Pashley DH, Whitford GM. Systemic distribution of 14C-formaldehyde from formocresol-treated pulpotomy sites. J Dent Res 1980;59:602-608.
  10. Balata GF, Abdelhady MIS, Mahmoud GM, Matar MA, Abd El-Latif AN. Formulation of Saudi Propolis into Biodegradable Chitosan Chips for Vital Pulpotomy. Curr Drug Deliv 2018;15:97-109
  11. Kumirska J, Weinhold MX, Thöming J, Stepnowski P. Biomedical activity of chitin/chitosan based materials—influence of physicochemical properties apart from molecular weight and degree of N-acetylation. Polymers 2011; 3:1875-1901
  12. Rinaudo M. Chitin and chitosan: properties and applications. J Prog Polym Sci 2006; 31:603-632
  13. Soares DG, Rosseto HL, Basso FG, Scheffel DS, Hebling J, Costa CA. Chitosan-collagen biomembrane embedded with calcium-aluminate enhances dentinogenic potential of pulp cells. Braz Oral Res 2016;30:1-10
  14. Radwan-Pragłowska J, Piątkowski M, Deineka V, Janus Ł, Korniienko V, Husak E, et al. Chitosan-based bioactive hemostatic agents with antibacterial properties-synthesis and characterization. Molecules 2019;2624:2629
  15. Okamoto Y, Yano R, Miyatake K, Tomohiro I, Shigemasa Y, Minami S. Effects of chitin and chitosan on blood coagulation. Carbohydrate Polymers 2003;15:337-342
  16. Wu S, Zhou Y, Yu Y, Zhou X, Du W, Wan M, et al. Evaluation of Chitosan Hydrogel for Sustained Delivery of VEGF for Odontogenic Differentiation of Dental Pulp Stem Cells. Stem Cells Int 2019;19:1-14
  17. Fuks AB, Eidelman E. Pulp therapy in the primary dentition. Curr Opin Dent 1991;1:556-563
  18. Kassa D, Day P, High A, Duggal M. Histological comparison of pulpal inflammation in primary teeth with occlusal or proximal caries. Int J Paediatr Dent 2009;19:26-33
  19. Schroder U. Agreement between clinical and histologic findings in chronic coronal pulpitis in primary teeth. Scand J Dent Res 1977;85:583–587
  20. Dummer PM, Hicks R, Huws D. Clinical signs and symptoms in pulp disease. Int Endod J 1980;13:27-35
  21. Hicks MJ, Barr ES, Flaitz CM. Formocresol pulpotomies in primary molars: a radiographic study in a pediatric dentistry practice. J Pedod 1986;10:331-339
  22. Chandrashekhar S, Shashidhar J. Formocresol, still a controversial material for pulpotomy: A critical literature review. J Restor Dent 2014;2:114-124
  23. Myers DR, Shoaf HK, Dirksen TR, Pashley DH, Whitford GM, Reynolds KE. Distribution of 14C-formaldehyde after pulpotomy with formocresol. J Am Dent Assoc 1978;96:805–813
  24. Erpaçal B, Adıgüzel Ö, Cangül S, Acartürk M. A General Overview of Chitosan and its Use in Dentistry. Int Biol Biomed J. 2019;5:1-11
  25. Venkatesan J, Kim SK. Chitosan composites for bone tissue engineering–an overview. Mar Drugs 2010;8:2252-2266
  26. Imani Z, Imani Z, Basir L, Shayeste M, Abbasi Montazeri E, Rakhshan V. Antibacterial Effects of Chitosan, Formocresol and CMCP as pulpectomyon Enterococcus‎faecalis, Staphylococcus aureus and Streptococcus‎mutans. Iran Endod J 2018;13:342-350
  27. Yang X, Han G, Pang X, Fan M. Chitosan/collagen scaffold containing bone morphogenetic protein-7 DNA supports dental pulp stem cell differentiation in vitro and in vivo. J Biomed Mater Res 2011;108:2519-2526
  28. Farea M, Husein A, Halim AS, Abdullah NA, Mokhtar KI, Lim CK, Berahim Z, Mokhtar K. Synergistic effects of chitosan scaffold and TGFβ1 on the proliferation and osteogenic differentiation of dental pulp stem cells derived from human exfoliated deciduous teeth. Arch Oral Biol 2014;59:1400-1411
  29. Li F, Liu X, Zhao S, Wu H, Xu HH. Porous chitosan bilayer membrane containing TGF-β1 loaded microspheres for pulp capping and reparative dentin formation in a dog model. Dent Mater 2014;30:172-181
  30. Vargas KG, Packham B, Lowman D. Preliminary evaluation of sodium hypochlorite for pulpotomies in primary molars. Pediatr Dent 2006;28:511-517
  31. Farooq NS, Coll JA, Kuwabara A, Shelton P. Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. Pediatr Dent 2000;22:278-286
  32. Guelmann M, Fair J, Bimstein E. Permanent vs temporary restorations after emergency pulpotomies in primary molars. Pediatr Dent 2005;27:478-481
  33. Alhamshary A I, El-Bayoumy S Y. Clinical and radiographic evaluation of chitosan-zinc oxide eugenol mix in pulp capping of primary teeth. AJDSM. 2020;23:263-270
  34. Jayam C, Mitra M, Mishra J, Bhattacharya B, Jana B. Evaluation and comparison of white mineral trioxide aggregate and formocresol medicaments in primary tooth pulpotomy: Clinical and radiographic study. J Indian Soc Pedod Prev Dent 2014;32:13-18
  35. Shang Jia jian. Clinical study of chitosan on vital pulpotomy to deciduous teeth. Beijing J of stomatology. 2003;2:104-106
  36. Pogorielov MV, Sikora VZ. Chitosan as a hemostatic agent: current state. Eur J Med 2015;1:24-33
  37. Renard E, Amiaud J, Delbos L, Charrier C, Montembault A, Ducret M. et al. Dental pulp inflammatory/immune response to a chitosan-enriched fibrin hydrogel in the pulpotomised rat incisor. Eur Cell Mater 2020;40:74-87

Article Info

Contemp Pediatr Dent 2021:2(2):90-100

Received: 02 May 2021

Accepted: 28 June 2021

Online First: 01 July 2021

315 views

Full Text

File Downloads
pdf CPD_2021_52 1309

How to Cite

				
					Nihal R Kothari, S K Srinath, Sulakshana S, Aswathy T, Padmapriya S. Comparative evaluation of the efficacy of chitosan and formocresol as medicaments for pulpotomy in primary molars: A clinical pilot study. Contemp Pediatr Dent 2021:2(2):90-100.
				
			

Related Articles

Share Article

Under a Creative Commons license