Comparison of two vital pulp therapies in β-Thalassemic children

Leila Mounir El. Gibaly1Orcid,  Mohamed Zayed Radwan2Orcid,  Amr Mahmoud Abdel-Aziz3Orcid,  Ghada Yousef El. Kamah4Orcid

Highlights

This study compared two vital pulp therapy techniques: mineral trioxide aggregate pulpotomy and indirect pulp capping in children with β-thalassemia major who cannot withstand the stress of the dental chair for long.

Both techniques had high success rates with no statistically significant difference between them. However, patient satisfaction was higher with indirect pulp capping than pulpotomy.
Both types of vital pulp therapies may be applied to β-thalassemic children with higher success rates.

Abstract

Aim: Beta-thalassemia (β-thalassemia) major is one of the most common inherited genetic blood disorders and is characterized by many systemic manifestations and skeletal problems. Children with β-thalassemia have a high caries index and must receive proper dental treatment to achieve better oral health. The aim of study is to compare two types of vital pulp therapies in children with β-thalassemia major. Methods: Sixty-five children with β-thalassemia major having carious primary molars were selected from Ain Shams University and the Hereditary Blood Disorders Clinic at the National Research Centre to be treated at Pediatric Dentistry, Department, Faculty of Dentisrtry, Ain Shams University . Patients received one of both types of vital pulp therapies: mineral trioxide aggregate (MTA) pulpotomy and indirect pulp capping. The children were divided into two groups as follow: Group I (n=30) received MTA pulpotomy and Group II (n=35) received indirect pulp capping using high viscosity glass ionomer cement. Clinical and radiographic follow-ups were done at the baseline, six months, and after one year. Patient preferences for types of vital pulp therapies were evaluated at the end of treatment. Comparison of the groups with qualitative data was done using Chi-square test. Comparison of the groups with quantitative data and a parametric distribution was done using an independent t-test at significance level 0.05. Results: The findings revealed success rates of 90% in Group I and 100% in Group II. There was 10% clinical and radiographic failure in Group I and 0% in Group II but the difference between the two groups when compared to each other was statistically not significant (p= 0.055). Conclusions: Both types of vital pulp therapies showed high success rates in children with β-thalassemia major and thus can be used safely in these patients. However, minimally invasive types of dental treatment may be preferred in children with β-thalassemia major as indirect pulp capping for being less invasive and requires less effort, fatigue and time.

Keywords: : Calcium Silicate; Dental Pulp Capping; Pulpotomy; Thalassemia 

Author Affiliations

  1. Research assistant in Oro-dental Genetics Department, Human Genetics and Genome Research Division, National Research center, El Buhouth street (formerly named Tahrir street), Ad Doqi, Dokki, Cairo, 12622. (✉ Correspondence: lucy_gb1511@yahoo.com)
  2. Lecturer in Pediatric Dentistry and Dental Public Health Department, Ain Shams University, Cairo, Egypt, 11566
  3. Professor in Pediatric Dentistry and Dental Public Health Department,Faculty of Dentistry, Ain Shams University Cairo, Egypt, 11566
  4. Professor of Clinical Genetics and Coordinator of Hereditary Blood Disorders and Genodermatosis Clinics and Research Division, National Research center, 33 El Buhouth street (formerly named Tahrir street), Ad Doqi, Dokki, Cairo, Egypt
  1. El-Kamah GY, Hosny LA, Sobh KS. Exploring Phenotypic Alterations in Response to High Hemoglobin F Level in Egyptian beta Thalassemia Patients. J Appl Sci Res 2009;5:1547-1551
  2. Bayrak S, Bulut DG, Orhan K, Sinanoglu EA, Çakmak EŞK, Misirli M, et al. Evaluation of Osseous Changes in Dental Panoramic Radiography of Thalassemia Patients Using. Mandibular Indexes and Fractal Size Analysis. Oral Radiol 2020;36:18-24
  3. Zhu G, Wu X, Zhang X, Wu M, Zeng Q, Li X. Clinical And Imaging Findings In Thalassemia Patients With Extramedullary Hematopoiesis. Clinic Imaging 2012; 36:475–482
  4. Bouguila J, Besbes G, Kochtali H. Skeletal Facial Deformity in Patients With β-Thalassemia Major: Report of One Tunisian Case and a Review of the Literature. Int J Pediatr Otorhinol 2015;79:1955-1958
  5. Al‐Raeesi S, Kowash M, Hassan A, Al‐Halabi M. Oral Manifestations and Dentofacial Anomalies in Β‐Thalassemia Major Children in Dubai (UAE). Spec Care Dent 2018;38:25-30
  6. Javid B, Al-Naief S. Craniofacial Manifestations of Β-Thalassemia Major. Oral Surg, Oral Med, Oral Pathol and Oral Radiol 2015;119:33-40
  7. Arora M, Nayeemuddin SM, Ghatak S, Singh B.Growth Impairment and Dental Caries in Thalassemia Major Patients. Indian J. Clinic Anatomy and Physiol 2014;1:15-21
  8. Adham S, Afifi H, Thomas M, Magdy P, El-Kamah G.Quality of Life Outcomes In A Pediatric Thalassemia In Egypt.Int J Hemo Res 2017;41:16-20
  9. Alalfy MS, Farid MN, Labib JH and Rezkallah H. Quality of life of Egyptian Β-Thalassemia Major Children and Adolescents. Egyptian J Haematol 2014;39:222-226
  10. Amirabadi F, Saravani S, Miri-Aliabad G, Khorashadi-Zadeh M. The Association Between Dental Health Status And Oral Health-Related Quality Of Life In Children Diagnosed With Β-Thalassemia Major In Zahedan City, Iran. Int J Pediatr 2019;7:8985-8991
  11. Madmoli Y, Madmoli M, Davoodi N, Niksefat M, Saberipour B, Darabiyan P, et al. Health Related Quality Of Life In Patients With Β-Thalassemia Major in Northern Khuzestan Province, Southwest of Iran in 2015-2016. J Res Med Dent Sci 2019;7:164-169
  12. Labrini F, Oubenyahya H. Dental Management of Beta Thalassemia Major Patients: A Review. Int J Med and Health Res 2018;4:1-5
  13. American Academy of Pediatric Dentistry (AAPD). Guideline on Pulp Therapy for Primary and Immature Permanent Teeth. Pediatr Dent 2016;17:280-288
  14. American Academy of Endodontists. Policy statement on the use of Dental Dams. [Internet] [cited 2017 Oct 20]. Available from: https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/06/dentaldamstatement.pdf
  15. AAPD Reference Manual 2018/19.Guidelines onRadiographic Prescription for Children, Adolescents and Individuals with Special Health Care Needs. Pediatr Dent 2019;40:213-215
  16. Zakaria N. Saving the Pulp and Essential Issues in Pulp-Capping Treatment. J Dentofac Sci 2016;1:73-76
  17. Fuks B, Guelmann M, Kupietzky A. Current Developments in Pulp Therapy for Primary Teeth. Endod Topics 2012;23:50-72
  18. Fuks B, Hebling J, De Souza A, Costa A. The Primary Pulp: Development And Biomedical Background.In: Fuks B, Peretz B. Editors. Current Concepts in Vital Pulp Therapy for Primary and Young Permanent Teeth. Pediatric Endodontics 2016. p. 8-21
  19. Fuks AB, Kupietzky ARI, Guelmann M. Pulp Therapy for The Primary Dentition. In: Nowak AJ, Christensen JR, Mabry TR, Townsend JA, Wells MH. editors. Pediatric Dentistry Infancy through Adolescence. USA: Elsevier; 2019. p.337-338
  20. Jan I, Shah FA, Ali A, Zain M, Afridi R, Khan AM, et al. Efficacy of Formocresol and Mineral Trioxide Aggregate Pulpotomy among Primary Molars: A Randomized Control Trial. Pakistan Oral Dent J 2019;39:289-292
  21. Basak F, Akgun OM, PolatGG, Altun C. Clinical and Radiographic Evaluation of the Effectiveness of Formocresol, Mineral Trioxide Aggregate, Portland Cement, And Enamel Matrix Derivative In Primary Teeth Pulpotomies: A Two Year Follow-Up. J Clin Pediatr Dent 2016; 40:14-20
  22. Vidya KB, Patil SB, Anegundi RT. Is Pulpotomy Obsolete? A Clinical Study on the Success Rates Of Indirect Pulp Capping and Pulpotomy in the Treatment of Deep Dentinal Caries in Primary Second Molars. J Int Clinic Dent Res Or 2015;7:24-28
  23. Da Rosa LO, Cocco AR, Silva TM, Mesquita LC, Galarca AD, Silva AF, et al. Current Trends and Future Perspectives of Dental Pulp Capping Materials: A Systematic Review. J Biomed Mat Res B: Appl Biomat 2018;106:1358-1368
  24. Jenqueira MA, Cunha NN, Caixeta FF, Marques NCT, Oliveira TM, Moretti ABS, et al. Clinical, Radiographic and Histological Evaluation of Primary Teeth Pulpotomy Using MTA and Ferric Sulfate. Brazilian Dent J 2018;29:159-165.
  25. Godhi B, Tyagi R. Success Rate of MTA Pulpotomy on Vital Pulp of Primary Molars: A 3 Year Observational Study. Int J Clinic Pediatr Dent 2016; 9:222-227
  26. Fuks AB. Vital Pulp Therapy with New Materials for Primary Teeth: New Directions and Treatment Perspectives. Pediatr Dent 2008;30:211-219
  27. Oliveira TM, Moretti AB, Sakai VT, Lourenço Neto N, Santos CF, Machado MA,Abdo RC. Clinical, Radiographic and Histologic Analysis of the Effects of Pulp Capping Materials Used In Pulpotomies of Human Primary Teeth. Eur Arch Paediatr Dent 2013;14:65-71
  28. Mello B, Stafuzza TC,Vitor L, Rios D,Silva T,Machado M, et al. Evaluation of Dentine Pulp Complex Response after Conservative Clinical Procedures in Primary Teeth. Int J Clinic Pediatr Dent 2018;11:188-192
  29. Stafuzza TC, Vitor LLR, Rios D, Silva T, Machado AM and Marchini T. Clinical and Radiographic Success of Selective Caries Removal to Firm Dentin in Primary Teeth: 18-Month Follow-Up. Case Rep Dent 2018:1;1-4
  30. Schwendicke F, Paris S, Tu YK. Effects of Using Different Criteria for Caries Removal: A Systematic Review and Network Meta-Analysis. J Dent 2015;43:1-15
  31. Faugeron VS, Porot A, Bolla MM, Courson F. Indirect Pulp Capping Versus Pulpotomy For Treating Deep Carious Lesions Approaching The Pulp In Primary Teeth: A Systematic Review. Eur J Paediatr Dent 2016;17:107-112
  32. Banerjee A. Minimal Intervention Dentistry: Part 7. Minimally Invasive Operative Caries Management: Rationale and Techniques. British Dent J 2013;214:107-111
  33. Freitas MF, Santos J, Fuks A, Bezerra A, Azevedo T. Minimal Intervention Dentistry Procedures: A Ten year Retrospective Study. J Clin Pediatr Dent. 2014;39:64-67
  34. Petrou MA, Alhamoui FA, Welk A, Altarabulsi MB, Alkilzy MH, Splieth C. A Randomized Clinical Trial on the Use of Medical Portland Cement, MTA and Calcium Hydroxide in Indirect Pulp Treatment. Clinic Oral Invest 2013;18:1383-1389
  35. Franzon R, Guimaraes LF, Magalhaes CE, Haas AN, Araujo FB. Outcomes Of One-Step Incomplete And Complete Excavation In Primary Teeth: A 24-Month Randomized Controlled Trial. Caries Res 2014;48:376-383
  36. Chauhan A, Dua P, Saini S, Mangla R, Butail, Ahluwalia S. In Vivo Outcomes of Indirect Pulp Capping In Primary Posterior Teeth: A 6 Months Follow-Up. Contemp Clinic Dent 2018; 9:69-73
  37. Al-Zayer MA, Straffon LH, Feigal RJ, Welch KB. Indirect Pulp Treatment of Primary Posterior Teeth: A Retrospective Study. Pediatr Dent 2003;25:29-36
  38. Vij R, Coll JA, Shelton P, Farooq NS. Caries control and other variables associated with success of primary molar vital pulp therapy. Pediatr Dent 2004;26:214-220
  39. Falster CA, Araújo FB, Straffon LH, Nör JE. Indirect pulp treatment: in vivo outcomes of an adhesive resin system versus calcium hydroxide for protection of the dentin-pulp complex. Pediatr Dent 2002;24:241-2448
  40. Ricketts D, Lamont T, Innes NPT, Kidd E, Clarkson E. Operative caries management in adults and children. Cochrane Database Syst Rev 2013;28:CD003808

Article Info

Contemp Pediatr Dent 2020:1(1):33-41

Received: 03 October 2020

Accepted: 04 December 2020

Online First: 15 December 2020

DOI: 10.51463/cpd.2020.23

165 views

Full Text

File Downloads
pdf CPD 2020 23 1133

How to Cite 

				
					Leila Mounir El. Gibaly, Mohamed Zayed Radwan, Amr Mahmoud Abdel-Aziz, Ghada Yousef El. Kamah. Comparison of Two Vital Pulp Therapies In β-Thalassemic Children. Contemp Pediatr Dent 2020:1(1):33-41.

Related Articles

Share Article

Under a Creative Commons license
Tagged
BACK TO TOP
Article Categories
Resources
About Us
Stay Connected
Follow Us

Copyright © Contemporary Pediatric Dentistry. All rights reserved.

Electronic ISSN 2757-5705.

Contemporary Pediatric Dentistry

Copyright | Terms | Privacy Policy

Published by ARBU Academic Publishing.