الفهرس 
materials and methodsOnly 14 pages are availabe for public view
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Abstract
The dental pulpotomy technique involves the amputation of the coronal portion of the affected dental pulp. Treatment of the remaining vital radicular pulp tissue surface should preserve the vitality and function of all or part of the pulp’s remaining radicular portion. Thus, preserve the integrity of the dental arch form of the primary dentition in an intact state until it is replaced by the permanent dentition
Pulpotomy modalities in primary teeth can be classified by treatment objective into three categories which are devitalization, preservation and regeneration.
Our study was mainly concerned with regeneration as an ultimate objective of primary teeth pulpotomy with expectations that the pulpotomy agent will induce re¬parative dentin formation at the pulp-dentin border. Thus, leave the radicular pulp vital, healthy and completely enclosed within and protected by an odontoblast-lined dentin chamber. Addi¬tionally, the odontoclasts of an uninflamed pulp could enter into the exfoliative process at appropriate time and sustain it in a physiologic manner.
Through this scope and based on previous studies, this study was designed to compare the clinical and radiographic success rates of primary teeth pulpotomies between MTA, a material with evidence-based success in many endodontic procedures including primary teeth pulpotomy, and EMD a novel biomaterial that has previously shown promising results as a valuable material for use in primary teeth pulpotomy.
The experimental part of this study was carried out on 24 premolars of 3 dogs 8 to 12 months old. The 24 premolars were divided equally into 2 main groups. Each premolar treated with Emdogain on the right side has its MTA treated premolar on the contralateral left side. In each side, 2 upper and 2 lower premolars were treated with one of the two materials. The 3 dogs were divided into 3 subgroups according to the time of scarification which was two weeks, 1 month and two months. The treated teeth were prepared and evaluated histologically.
The clinical part was carried on fifteen patients with an age range of 4 to 7 years, with bilateral deep carious mandibular primary molars; they were selected to meet the criteria recommended for pulpotomy. The thirty selected teeth were divided into two treatment groups of fifteen teeth each. group 1 was treated with EMD and group 2 was treated with MTA. Children were followed up at 1 month, 2 months and 3 months.
At each recall appointment, the children were examined clinically as regards to pain, sensitivity to percussion, abscess or fistula formation and mobility. Radiographic examination was also done to assess PDL widening, pathologic root resorption, periradicular radiolucency and pulp calcification.
At 1 month, on clinical examination, all teeth in the Emdogain treated group were free from pain, sensitivity to percussion, mobility, abscess and fistulous tract formation. This accounts for (100%) clinical success rate. This dropped to 93.3% at 2 months when one case (6.7%) presented with pain and sensitivity to percussion. At 3 months however, two teeth showed severe pain, sensitivity to percussion and mobility, one of which was extracted. This lowered the clinical success rate to 86.7%. At one month recall and on radiographic evaluation, all teeth treated with Emdogain showed radiographic success rate of 100%. At that time, there were no signs of PDL widening, pathologic root resorption, pulp calcification or periradicular radiolucency. However, this rate dropped to 93.3% at 2 months, when one case (6.7%) showed signs of PDL widening and periradicular radiolucency. Moreover, at 3 months, the success rate further dropped to 86.7% when the same case showed increased periradicular radiolucency and was extracted while another case (13.3%) showed obvious periradicular radiolucency as well.
Clinical evaluation of the cases showed that all the teeth treated with MTA pulpotomy remained free from history of pain, sensitivity to percussion, mobility, abscess or fistulous tract formation through out the whole observation period of 3 months reporting a clinical success rate of 100%. Radiographic evaluation of the cases showed that all the teeth treated with MTA pulpotomy remained free from PDL widening, pathologic root resorption, pulp calcification or periradicular radiolucency through out the whole observation period of 3 months reporting a radiographic success rate of 100%.
The histological evaluation of this study revealed that teeth treated with MTA showed a more favorable response than those treated with EMD. MTA was able to maintain the integrity of the odontoblastic layer throughout the dentin pulp complex. A thick layer of secondary dentin that was able to obliterate the amputation site was also observed. The moderate inflammation seen at the first observation period subsided and normal pulp architecture was seen by the end of the study. However, teeth treated with EMD showed loss of the integrity of the odontoblastic layer, irregular dentin bridging at the amputation site and marked inflammation of the pulp with signs of pulp degeneration.