Comparative Evaluation of Clinical and Radiographic Outcomes of Indirect Pulp Treatment with Silver Diamine Fluoride Versus Calcium Hydroxide in Primary Teeth: A Randomized Controlled Trial

Background: Indirect pulp treatment (IPT) has been a minimally invasive procedure for deep dentinal caries with considerable success. IPT is a procedure which involves excavation of infected dentin and keeping affected dentin intact, followed by application of IPT agent and restoration. The aim of the study was to evaluate and compare clinical and radiographic outcomes of IPT with silver diamine fluoride (SDF) and calcium hydroxide in primary teeth. Materials and Methods: The present study is a prospective, parallel, randomized controlled trial. The study was conducted with a sample size of 50 primary molars in 4 to 7 year old children. In Group A, 25 teeth each were considered for SDF whereas, 25 teeth for calcium hydroxide IPT (Group B). Clinical and radiographic outcomes were evaluated at baseline, three and six months and were compared for both the groups. Data obtained was analyzed using Fisher’s exact test. Level of significance was set at p<0.05. Results: On statistical analysis of clinical and radiographic outcomes between both the groups IPT using SDF showed 96% success rate at six month follow up whereas IPT using calcium hydroxide showed 88% success. However, there was no statistically significant difference found between the groups. Conclusions: SDF can be used as an effective alternative of calcium hydroxide for IPT in primary molars. Keywords: Indirect pulp treatment, Calcium hydroxide, Silver diamine fluoride, Primary teeth.

Frequency of Pulp Treatments in a Peruvian Pediatric Population: a Retrospective Study in a Specialized Dental Center from 2015 to 2019

Pulp treatments are one of the types of procedures most performed in pediatric patients, whose primary objective is to restore the masticatory, aesthetic and phonetic function. The objective of this study was to determine the frequency of pulp treatments performed in patients from 3 to 11 years of age treated at the Pediatric Dentistry Service of the Centro Dental Docente Cayetano Heredia from January 2015 to December 2019. The search for the medical records of patients treated at the Pediatric Dentistry Service who have met the inclusion and exclusion criteria. Data were collected on age, sex, type of dentition and tooth, for the elaboration of a database, and later tables of contents. Of a sample of 514 virtual medical records, with 1166 pulp treatments performed, indirect pulp treatment was the most performed for both sexes, 41.17% (n=247) for females and 34.98% (n=198) for males. According to age range, 3 to 5 years of age are the patients who received more indirect pulp treatment with 39.06% (n=359). The majority of patients with deciduous dentition underwent indirect pulp treatment with 39.32% (n=326). Being the tooth most treated with indirect pulp treatment 84 with 41.18% (n=70). The pulp treatment that was most performed in our study was indirect pulp treatment followed by pulpectomy and pulpotomy. The female sex, age group 3 to 5 years and deciduous dentition were the ones that received the most pulp treatments. The teeth with the highest frequency of pulp treatments were the second lower left molar and the first lower right molar, and those with the least frequency were the lower right and left canines.

Proteção da vitalidade dentino-pulpar em odontopediatria: uma revisão de literatura

Dentin and pulp are considered interdependent substrates, known as the dentin-pulp complex. In front of injuries such as caries and trauma, this complex should be protected with restorative materials considered to be protective agents. An ideal material should have properties such as biocompatibility, be antimicrobial, be insoluble in the oral environment, be thermal and electrically insulating, have therapeutic potential, and adequate mechanical properties. As these characteristics are not found in all materials, the dentist must know the advantages and disadvantages of those that are available. This study aimed to perform a critical review of the indirect materials indicated for the protection of dentin-pulp vitality (PDPV) to ensure the success of indirect pulp treatment in primary teeth. A search was carried out in books, theses, dissertations, monographs, printed articles and databases, PubMed, SciELO, and MEDLINE. According to the literature, the success in protecting the dentin-pulp vitality is achieved through an excellent marginal seal, preventing bacterial infiltration in the dentin and controlling the progression of caries. Further clinical studies are needed to evaluate other outcomes after indirect pulp treatment. There isn’t a material that has all the desired characteristics for PDPV, and recent studies show that the key to PDPV isn’t found in the protective material, but in the restorations marginal sealing, enabling the inactivation of the progression of dental caries.