MTA Sebagai Alternatif PSA

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MTA pulpotomy as an alternative to

root canal

treatment in children’s permanent teeth in a dental

public health setting

Hend E. Alqaderia, Sabiha A. Al-Mutawa a, Muawia A. Qudeimat b,* aOral

Health

Services,

Ministry

of

Health,

KuwaitbDepartment

of

Developmental

and

Preventive

Sciences,

Kuwait

University,

Kuwait

1. Introduction

The dental pulp is an integral element of tooth structure. A

vital pulp tissue is responsible for supporting the tooth

structure

through

reparative

dentine

production.

Preserving

pulp vitality is essential in maintaining vascularization and

nutrition to the tooth that eventually will support tooth

structure and reduce teeth mortality.

j o u rna l o f d en t i s t r y 4 2 ( 2 0 1 4 ) 1 3 9 0 – 1 3 9 5

a r t i c l e i n f o

Article history:

Received 6 March 2014

Received in revised form

17 June 2014

Accepted 18 June 2014

Keywords:

MTA

Pulpotomy

Carious exposurePermanent teeth

Children

a b s t r a c t

Objective: This prospective clinical study evaluated the success of vital pulpotomy treat-

ment for permanent teeth with closed apices using mineral trioxide aggregates (MTA) in a

dental public health setting.

Methods: Twenty-seven mature permanent first molars and 2 premolars (in 25 patients)

with carious exposure were treated using MTA pulpotomy. Age of patients ranged from

10- to 15-years (mean= 13.2 1.74-years). Four trained and calibrated practitioners per-

formed the same clinical procedure for all patients. Following isolation and caries removal,

the inflamed pulp tissue was completely removed from the pulp chamber. This was

followed by irrigation with 2% sodium hypochlorite. Haemostasis was achieved using a

cotton pellet damped in normal saline. A white MTA paste was placed against the pulp

orifices. MTA was covered with a damped cotton pellet and a base of IRM. Patients wererecalled after

1 day where a glass ionomer liner and a final restoration were placed. Teeth

were evaluated clinically and radiographically for up to 47 months.

Results: Mean follow-up period for all teeth was 25 14 months. Twenty-six of the 29 teeth

were clinically asymptomatic with no evidence of periradicular or root pathology during

the follow-up period. The estimated success rate was 90%. Three teeth presented with

clinical symptoms of pain and radiographic evidence of periradicular pathology that

indicated root canal treatment (RCT) or extraction.

Conclusion: When managing carious pulp exposures of permanent teeth with closed root

apices in children, MTA pulpotomy showed a high success rate.

Clinical significance: MTApulpotomyforpermanentmolars in children is a viablealternative

to RCT.

#

2014 Elsevier Ltd.

All rights reserved.

* Correspondingauthorat: Departmentof Developmental andPreventiveSciences, Facultyof Dentistry,Kuwait University, P.O. Box24923,

Safat 13110, Kuwait. Tel.: +965 2463 6747; fax: +965 25326 049.

E-mail address: [email protected] (M.A. Qudeimat).

Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.intl.elsevierhealth.com/journals/jden

http://dx.doi.org/10.1016/j.jdent.2014.06.007

0300-5712/# 2014 Elsevier Ltd. All rights reserved.



Root

canal

treatment

for

permanent

teeth

in

children

is

a

complex procedure requiring lengthy appointments and

multiple visits and often requires a full coverage restoration.

On the other hand, vital pulpotomy requires shorter appoint-

ments and usually can be accomplished in one visit. Also,

while an endodontist is usually required to perform RCT, a

paediatric

dentist

or

a

general

dental

practitioner

can

perform

vital pulpotomy for permanent teeth. By providing analternative to the progressive conventional RCT in children,

vital pulp therapy can help retain vital permanent teeth that

are

able

to

withstand

normal

functions.

In

a

recently

published

systematic

review,

authors

concluded

that

vital

pulp therapy should be considered as an alternative treat-

ment to RCT in vital permanent teeth with carious exposed

pulp.1 They also stated that there is a need forfurther studies

in vital pulp therapy, as the current evidence provides

inconclusive

information

regarding

factors

influencing

treat-

ment

outcomes.1

In Kuwait, the total number of children and adolescents

aged 5–19 years is 378,365.2 In this age group, 95,743

permanent tooth canal received RCT between 2007 and 2012in

the

School

Oral

Health

Programme

(SOHP)-Ministry

of

Health. In such a dental public health setting, substituting RCT

with vital pulp therapy can decrease the number of patients

receiving RCT, and consequently, the cost of treatment.

Currently,

mineral

trioxide

aggregates

(MTA)

is

accepted

as

an optimum material for use in vital pulp therapy of

permanent

teeth.3,4 MTA

clinical

outcome

is

reported

to

be

due mainly to its long-term sealing ability and the stimulation

of a high quality and a great amount of reparative dentin.3,5 In

human clinical trials carried out on cariously exposed

permanent

teeth,

the

success

rate

of

vital

pulp

therapy

using MTA was considered to be high and ranged from 93 to

100%.6–12 However, there is a limited number of studiesreporting on the success of vital pulpotomy for mature

permanent

teeth

in

children

and

adolescents

using

MTA.8,10,12 It was therefore the objective of the current study

to investigate the success of vital pulp therapy for mature

permanent teeth using MTA as an alternative to conventional

RCT in children and adolescents in a dental public health

setting.

2.

Materials

and

methods

This

prospective study

was

conducted

at the

School

Oral

HealthProgramme Clinics-Ministry of Health,Kuwait. Ethicalapproval was obtained from Health Sciences Ethical Clear-

ance Committee-Kuwait University. Prior to examination,

consents were taken from parents of all participating

children.

To

be

considered

for

this

study,

patients

were

required

to

be

medically

healthy,

have

a

restorable

mature

permanent

molar or premolar with deep caries and a diagnosis of

reversible pulpitis. Exclusion criteria included patients with

history of severe pain, history of swelling or a fistula

associated

with

the

tooth,

tenderness

on

percussion

or

palpation, pathologic mobility, or an abnormal response to

cold testing (Endo-Ice, Hygenic Corp, Akron, OH). Radio-

graphic inclusion criteria included: teeth with closed apecies

and

the

absence of

radiographically visible periradicular

pathologies. Clinically,teeth with hyperaemicpulpthat could

not be controlled within 5 min were also excluded from the

study. One investigator (with 7-years clinical experience in

treating pulpally affected primary and permanent teeth in

children) trained and calibrated three clinicians for this

study.

Four clinicians carried out diagnosis

and treatment

for all cases.

2.1. Treatment procedure

After

anaesthetizing

and

isolating

the

tooth

using

a

rubber

dam,

caries was removed using a large round, low-speed carbide bur

(Gebr.Brasseler1, Germany). Patients treated with indirect or

direct pulp capping, partial pulpotomy or RCT were excluded

from the study. The treatment decision was made based on the

extent

of

inflammation

in

the

coronal

pulp

and

the

bleeding

time; bleeding

that

stopped

within

few

minutes

indicated

a

healthy status of the remaining pulp in the canals.13 Each

patient received two dental visits in order to complete the

procedure. During the first visit, the standard pulpotomyprocedure

was

performed,

removing

the

infected

coronal

pulp

tissue to the level of the floor of the pulp chamber and orifices by

using a high-speed diamond bur (Gebr.Brasseler1, Germany)

with copious sterile water. A sterile cotton pellet damped in

normal

saline

was

used

to

control

the

bleeding.

A

layer

of

white

MTA (Pro Root1 MTA, Dentsply, Tulsa Dental, USA) paste,

prepared

by

mixing

MTA

powder

with

sterile

saline following

the manufacturer’s instructions was placed on the root canal

orifices. The MTA was condensed lightly with a moistened

sterile cotton pellet to achieve a 2–4-mm thickness. A damped

cotton

pellet

was

then

covered

with

a

temporary

filling

intermediate restorative material (IRM1, type III, Class 1 Caulk

Dentsply, USA). The patients returned the following day for asecond visit to complete the definitive restoration. In the second

visit,

the

cotton

pellet

and

IRM1 were

removed

and

the

MTA

was checked for hardening. Teeth were restored with a layer of

light cure glass ionomer liner (VitrebondTM, 3MTMESPETM, USA),

and incremental layers of composite restoration (Herculite1

XRV UltraTM, Kerr Italia, Italy) were applied and cured according

to the manufacturer’s instructions. Stainless steel crowns

(UnitekTM,

3MTM ESPETM,

USA)

were

used

over

the

composite

when more than two walls of the tooth were damaged. All

patients were instructed to call or return to the clinic if pain or

discomfort occurred, and in this case, symptoms were assessed

and

appropriate

treatment

provided.

All patients were scheduled for routine clinical andradiographic evaluations as per the SOHP guidelines. At each

follow-up visit, the treated tooth was examined for the

following adverse events: pain, swelling, sinus tract forma-

tion, tenderness on percussion or palpation, and radiographic

evidence

of

periradicular

or

furcal

pathology,

or

root

resorp-

tion.

Pulp

therapy

was

considered

successful

if

none

of

the

previous symptoms were present. Also, the quality of the

restoration was checked and the restoration was repaired if

deemed necessary. An examiner who was not involved in the

treatment

phase

of

this

study

evaluated

all

the

pre

and

post

treatment radiographs at the end of the study. The examiner

was blinded to the names of participant and dates of all

radiographs.

j o u rna l o f de n t i s t r y 4 2 ( 2 0 1 4 ) 1 3 9 0 – 1 3 9 5 1391



3. Results

Two patients with two treated teeth did not return for recall

visits, leaving 25 patients with 29 tooth for evaluation.

Twenty-seven of the teeth were permanent first molars and

two

were

first

premolars.

Although

many

patients

failed

to

return for regular follow up appointments at scheduled times,all of the cases were available for clinical and radiographic

examination at the closing date of the study. The follow up

evaluation

period

ranged

from

1

to

47

months

with

an

average

of

25

14

months.

Table

1

summarizes

the

characteristics

of

patients, distribution of teeth, clinical and radiographic

findings at the initial visit, the follow up period and fate of

all teeth included in this study. Treatment was considered

successful for 26 teeth (90%). One of the cases that failed

presented

after

one

month

of

pulpotomy

with

severe

pain

and

tenderness

to

touch.

The

second

failed

case

received

RCT

outside the SOHP and at the time of scheduled follow up

appointment the parent and child had no recollection of the

timing of the treatment. The third case failed at 47 months.The

child

presented

with

her

mother

complaining

of

pain

and

after clinical and radiographic assessment a decision was

made to extract the tooth.

Radiographically, no signs of periradicular bone or root

resorption

were

noted

in

any

of

the

successfully

treated

teeth.

Also, no evidence of internal root resorption or pulp canal

calcifications

were

detected

on

radiographs.

A

radiographic

hard

tissue

bridge

underneath

the

MTA

layer

was

observed

in

10 cases (34%).

4. Discussion

Clinically,

a

principal

challenge

faced

by

most

paediatric

dentists, endodontists or general dentists with special interestin treating children is the treatment of pulpally involved and

abscessed teeth in a young patient. This is mainly due to

factors

related

to

patient’s

cooperation,

the

total

number

of

visits

required

to

finish

the

treatment

and

the

cost

of

treatment. This is further complicated by disagreement on

treatment protocols and outcomes among clinicians, which is

often based on little or no documented evidence.14

It has long been known that healthy dental pulp cells have

the

potential

to

develop

into

odontoblasts.15 This

allows

pulp

tissue

to

regenerate

and

repair.15,16 Authors

suggested

that

aged pulp retains the ability to create dentine but at a

diminished rate.17,18 They also concluded that younger pulps

had a better likelihood of potential tissue healing andregeneration.17,18 An

explanation

for

this

could

be

provided

from a recent review on dental pulp stem cells where the

authors demonstrated that ageing was related to reduction of

pulpal cell populations leading to compromised pulpal wound

healing

and

regeneration

with

increasing

age.19

Recent studies have shown high success rates for vital pulp

therapy

in

maintaining

the

vitality

of

dental

pulp

tissues

in

Table 1 – Distribution and fate of 29 teeth that were cariously exposed and treated by pulpotomy using MTA.

Case

number

Gender

Tooth

Age

at

treatment

(years)

Follow-up

time (months)

Final

restoration

Fate

1 F 36 13.1 47 Composite Successful

2 F 36 13 45 Composite Successful

3 F 36 11.5 43 Composite and SSC Successful




7 F 46 11.8 47 Composite Failure

8 M 46 13 40 Composite Successful



11 M 16 15.1 3 Composite Successful

26 15.1 3 Composite Successful


16

15.1 21 Composite Successful13 M 36 14.4 24 Composite Successful



26

12.2 21 Composite Successful









24 F 16 14.3 1 Composite Failure

46

11 24 Composite Successful

25 F 36 15.3 Unknown Composite Failure

j o u rna l o f d e n t i s t ry 4 2 ( 2 0 1 4 ) 1 3 9 0 – 1 3 9 51392



young

permanent

teeth

with

open

root

apices.6,7,9,20 On

the

other hand, for teeth with closed root apices, the best

treatment option under similar pulpal conditions is RCT.

Ricucci et al.14 in a recent 5-year prospective study reported on

an overall success rate of 89% for conventional RCT in

816 tooth. However, endodontic treatment for mature molar

teeth

has

been

reported

to

increase

the

incidence

of

tooth

fractures.21 This is usually due to the loss of tooth structureand induced stresses caused by endodontic and restorative

procedures which will eventually weaken the tooth and

make

it

more

susceptible

to

fracture.21Therefore,

maintaining

tooth

vitality

enhances

dentinal

root

deposition

and

results

in stronger root structure.

The aim of vital pulpotomy in permanent teeth in children

is to treat reversible pulpal injuries and to maintain radicular

pulp vitality and function and therefore maintain the tooth in

a

viable

condition.

Few

studies

have

reported

on

the

outcome

of

pulpotomy

for

cariously

exposed

pulps

in

permanent

teeth

with closed apices.10,12 Barngkgei et al.12 evaluated the clinical

and radiographic outcome of pulpotomy treatment with MTA

in symptomatic mature permanent teeth with cariousexposures

in

adults

(mean

age

29

years).

The

authors

reported

on a 100% success rate. The final restoration was either

polycarboxylate cement and amalgam restoration or full

coverage crown.12 However, the sample size was small

(10

patients

with

11

teeth)

of

which

5

teeth

were

molars,

5 premolars and 1 central incisor. In the current study, the

success

rate

was

90%.

The

majority

of

the

treated

teeth

were

molars (27) and two teeth were premolars. Also, the mean age

of patients in this study was 13 years.

The selection of the pulp cap material is a significant factor

in

the

success

of

any

vital

pulp

therapy.9,22 In

this

study,

white-MTA was used for pulp capping after pulpotomy

because of its favourable sealing ability, biocompatibility,dentinogenic activity and its clinical encouraging out-

comes.6,7,9–12,22–25 In

applying

MTA

as

a

pulp

cap

material,

it

is postulated that MTA will provide an impenetrable barrier

against any future bacterial leakage into the vital pulpal

canals.25 This will help in maintaining an intact remaining

vital pulp that could heal and regenerate additional dentinal

root tissues, resulting in more supportive tooth structure.25

Recent

clinical

studies

on

direct

pulp

capping

and

partial

pulpotomy in treating cariously exposed permanent teeth

have supported the concept that dental pulp has the ability to

remain vital after removing infected pulp tissue.6,7,9–12,26–28 In

the

current

study,

after

the

removal

of

the

infected

coronal

pulp tissue and sealing the remaining pulpal canal with MTA,the pulp tissue healed and maintained vitality in 90% of the

teeth during the follow up period. In a previous randomized

clinical study, investigators compared the clinical and

radiographic outcomes of pulpotomy in permanent molars

with

irreversible

pulpitis

using

calcium

enriched

mixture

cement

(CEM)

with

those

treated

with

MTA.10 The

sample

had

an average age of 27

8 years and molars were mature. After a

short follow up period of 12 months, the clinical and

radiographic success rates for the MTA and CEM groups were

98%

and

95%,

respectively.10

Although one advantage for using white MTA in this study

was to reduce the treated tooth’s discolouration potential,

there have been recent reports suggesting that when in

contact

with

sodium

hypochlorite

solution,

white

MTA

can

cause discolouration.29 When the teeth are restored with

stainless steel crowns, this does not seem to represent an

aesthetic problem.30 In this investigation, white MTA wasused

in all cases and 28 teeth received resin restorations. However,

discolouration of treated molars was not investigated. There is

a

possibility

that

for

failed

cases

in

this

study,

the

colour

of

the

tooth was part of the assessment criteria upon which dentistsbased their diagnosis of irreversible pulpitis or a non-vital

tooth. Therefore, it is imperative that parents and dentists are

educated

about

the

possibility

of

teeth

colour

changes

with

the

use

of

MTA

in

vital

pulpotomy.

The experience of root canal associated pain is a major

source of fear for patients and a very important concern of

dentists.31 Oginni and Udoye32 documented that 18% of the

patients who received a single visit RCT reported pain 30 days

postoperatively.

In

a

recent

systematic

review,

it

was

concluded

that

14%

of

patients

receiving

RCT

would

have

postoperative pain 1 week after treatment.31 However, in the

current study and except for the three failed cases, the parents

of participants reported either immediate relive of pain or nopostoperative

flare-ups.

This

is

supported

by

a

study

that

compared the mean pain intensity and pain in response to

percussion tests between a single visit RCT and pulpotomy

for permanent teeth with irreversible pulpitis. Over 7 days

observation

period,

patients

in

the

RCT

group

experienced

statistically significantly more pain than those in the

pulpotomy

group.33

Posterior resin composite restorations placed in children

and adolescents demonstrated good durability and low

annual failure rate.34–36 However, deteriorating surface

restoration

leading

to

bacterial

leakage

is

the

likely

reason

for the increasing failure rate of pulp therapy observed in

clinical follow-ups carried out over long periods of time.37,38

This could lead to marginal bacterial leakage into the

remaining

vital pulp tissue

and can consequently compro-

mise healing, resulting in pulpal necrosis.39 It has been

reported that the most effective restorative materials to

prevent bacterial microleakage and pulp injury from

inflammatory activity were high viscosity glass ionomer,40

resin-modified glass ionomer, bonded amalgam,41 resin

restorations41 and

stainless steel

crowns.6,9 However, the

frequency of bacterial microleakage related to resin com-

posites was found to be 20%.41 This could have been a

possible reason for the failure of the three cases seen in this

study,

especially

that

most

of

the

teeth

in

this

study

required

large restorations.It has been stated that non-vital immature teeth, due to

fragile roots, are more prone to fracture than mature teeth.42,43

Root fractures commonly occur in the cervical third of teeth

that receive apexification treatment.42 For immature end-

odontically

treated

teeth,

it

was

found

that

the

frequency

of

cervical

fractures

ranged

between

28

and

77%

depending

on

the stage of tooth development.44 Studies thus far have not

investigated the frequency of cervical fractures following vital

pulpotomy using MTA in permanent posterior teeth. However,

over

the

follow-up

period

of

this

study,

none

of

the

treated

teeth suffered cervical root fractures.

Limitations of the present study include: (1) the small

experimental sample size, (2) more than one clinician




performed the diagnosis and treatment procedure, (3) the

relatively short period of follow-up after treatment, in

particular, cases that were followed up for less than 6

months. In this respect, it is important to understand that

the assumption that the effect of different factors (e.g.

operator’s determination of the diagnosis and the quality of

the restoration) in clinical trials remains the same over

time should be routinely checked,35 (4) the inability toperform EPT pulp testing in our public health setting on a

regular basis, and (5) the poor compliance of patients with

routine follow-up appointments. Moreover, to ascertain

the success of pulpotomy as an alternative to RCT, a

randomized control trial is highly recommended to deter-

mine the long-term outcomes and cost effectiveness of

both pulpotomy and RCT.

5. Conclusion

Vital pulpotomy treatment can be used successfully as an

alternative to root canal treatment in the management of carious pulp exposure for fully erupted mature teeth in

children to maintain pulp vitality and provide strength that

supports tooth structure. By validating this new, less

invasive approach, vital pulpotomy has great potential to

further improve patient’s dental care.

Acknowledgments

This study was supported by School Oral Health Program,

Ministry of Health, Kuwait. We would like to thank

Hawally & Mubarak Alkabeer SOHP’s staff who took the

time and effort to contribute to the research.

r

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f

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1. Aguilar P, Linsuwanont P. Vital pulp therapy in vitalpermanent teeth with cariously exposed pulp: a systematicreview. Journal of Endodontics 2011;37:581–7.

2. Annual Statistical Abstract 2011. Population. Kuwait Central

Statistical Bureau. 2011. [Chapter 3].3. Witherspoon DE. Vital pulp therapy with new materials:new directions and treatment perspectives—permanentteeth. Journal of Endodontics 2008;34:S25–8.

4. Bakland LK, Andreasen

JO. Will mineral trioxide

aggregatereplace calcium hydroxide in treating pulpal andperiodontal healing complications subsequent todental trauma? A review.

Dental

Traumatology 2012;28:

25–32.5. Parirokh M, Torabinejad M. Mineral trioxide aggregate: acomprehensive literature review—Part III: clinicalapplications, drawbacks, andmechanism of action. Journal

of Endodontics 2010;36:400–13.6. Barrieshi-Nusair KM, Qudeimat MA. A prospective clinicalstudy of mineral trioxide aggregate for partial pulpotomy incariously exposed permanent teeth. Journal of Endodontics

2006;32:731–5.7. El-Meligy OA, Avery DR. Comparison of mineral trioxideaggregate and calcium hydroxide as pulpotomy agents in

young permanent teeth (apexogenesis). Pediatric Dentistry

2006;28:399–404.8. Miyashita H, Worthington HV, Qualtrough A, Plasschaert A.Pulp management for caries in adults: maintaining pulpvitality. The Cochrane Database of Systematic Reviews 2007;18. [CD004484].

9. Qudeimat MA, Barrieshi-Nusair KM, Owais AI. Calciumhydroxide vs mineral trioxide aggregates for partial

pulpotomy of permanent molars with deep caries. European Archives of Paediatric Dentistry 2007;8:99–104.

10. Asgary S, Eghbal MJ. Treatment outcomes of pulpotomy inpermanent molars with irreversible pulpitis using biomaterials: a multi-center randomized controlled trial. Acta Odontologica Scandinavica 2013;71:130–6.

11. Ghoddusi J, Shahrami F, Alizadeh M, Kianoush K, ForghaniM. Clinical and radiographic evaluation of vital pulp therapyin open apex teeth withMTA and ZOE.New York State Dental

Journal 2012;78:34–8.12. Barngkgei IH, Halboub ES, Alboni RS. Pulpotomy of

symptomatic permanent teeth with carious exposure using mineral trioxide aggregate. Iranian Endodontic Journal

2013;8:65–8.13. Duncan HF, Nair PNR, Pitt Ford TR. Vital pulp treatment: a

review. Endo 2008;2:247–58.14. Ricucci D, Russo J, Rutberg M, Burleson JA, Spangberg LS.

A prospective cohort study of endodontic treatments of 1,369 root canals: results after 5 years. Oral Surgery

Oral

Medicine Oral Pathology Oral Radiology and Endodontics

2011;112:825–42.15. Huang GT. A paradigm shift in endodontic management of

immature teeth: conservationof stem cells for regeneration. Journal of Dentistry 2008;36:379–86.

16. Tziafas D. The future role of a molecular approach to pulp-dentinal regeneration. Caries Research 2004;38:314–20.

17. Matsuzaka K, Muramatsu T, Katakura A, Ishihara K,Hashimoto S, YoshinariM, et al. Changes in thehomeostaticmechanism of dental pulp with age: expression of the core-binding factor alpha-1, dentin sialoprotein, vascular

endothelial growth factor, and heat shock protein 27messenger RNAs. Journal of Endodontics 2008;34:818–21.

18. Holland GR, Torabinejad M. The dental pulp andperiradicular tissues. In: Torabinejad M, Walton RE, editors.Endodontics: principles and practice. 4th ed. St. Louis, Missouri:Saunders Elsevier; 2009. p. 1–20.

19. Sloan AJ, Waddington RJ. Dental pulp stem cells: what,where, how? International Journal of Paediatric Dentistry

2009;19:61–70.20. Nosrat A, Seifi A, Asgary S. Pulpotomy in caries-exposed

immature permanent molars using calcium-enrichedmixture cement or mineral trioxide aggregate: arandomized clinical trial. International Journal of Paediatric

Dentistry 2013;23:56–63.21. TangW,WuY, Smales RJ. Identifying and reducing risks for

potential fractures in endodontically treated teeth. Journal of Endodontics 2010;36:609–17.

22. Tomson PL, Grover LM, Lumley PJ, Sloan AJ, Smith AJ,Cooper PR. Dissolution of bio-active dentine matrixcomponents by mineral trioxide aggregate. Journal of

Dentistry 2007;35:636–42.23. Karabucak B, Li D, Lim J, Iqbal M. Vital pulp therapy with

mineral trioxide aggregate. Dental Traumatology 2005;21:240–3.

24. Nair PN, Duncan HF, Pitt Ford TR, Luder HU. Histological,ultrastructural and quantitative investigations on theresponse of healthy human pulps to experimentalcapping with mineral trioxide aggregate: a randomizedcontrolled trial. International Endodontic Journal 2008;41:128–50.

j o u rna l o f d e n t i s t ry 4 2 ( 2 0 1 4 ) 1 3 9 0 – 1 3 9 51394



25. Torabinejad M, Parirokh M. Mineral trioxide aggregate: acomprehensive literature review-part II: leakage andbiocompatibility investigations. Journal of Endodontics2010;36:190–202.

26. Mejare I, Cvek M. Partial pulpotomy in young permanentteeth with deep carious lesions. Endodontics and Dental

Traumatology 1993;9:238–42.27. Mente J, Geletneky B, Ohle M, Koch MJ, Friedrich Ding PG,

Wolff D, et al. Mineral trioxide aggregate or calciumhydroxide direct pulp capping: an analysis of theclinical treatment outcome. Journal of Endodontics2010;36::806–13.

28. Cho SY, Seo DG, Lee SJ, Lee J, Lee SJ, Jung IY. Prognosticfactors for clinical outcomes according to time after directpulp capping. Journal of Endodontics 2013;39:327–31.

29. Camilleri J. Color stability of white mineral trioxideaggregate in contact with hypochlorite solution. Journal of Endodontics 2014;40:436–40.

30. Cardoso-Silva C, Barberıa E,MarotoM, Garcıa-Godoy F. Clinicalstudy of mineral trioxide aggregate in primary molars.Comparison between Grey and White MTA—a long termfollow-up (84 months). Journal of Dentistry 2011;39:187–93.

31. Pak JG, White SN. Pain prevalence and severity before,

during, and after root canal treatment: a systematic review. Journal of Endodontics 2011;37:429–38.

32. Oginni A, Udoye CI. Endodontic flare-ups: comparison of incidence between single and multiple visits procedures inpatients attending a Nigerian teaching hospital. Odonto-StomatologieTropicale 2004;27:23–7.

33. Asgary S, Eghbal MJ. The effect of pulpotomy using acalcium-enriched mixture cement versus one-visit rootcanal therapy on postoperative pain relief in irreversiblepulpitis: a randomized clinical trial. Odontology 2010;98:126–33.

34. Sunnegardh-Gro ¨ nberg K, van Dijken JW, Funegard U,Lindberg A, Nilsson M. Selection of dental materials andlongevity of replaced restorations in Public Dental Health

clinics in northern Sweden. Journal of Dentistry 2009;37:673–8.

35. PallesenU, van Dijken JW, Halken J, HallonstenAL, Ho ¨ igaardR. Longevity of posterior resin composite restorations inpermanent teeth in Public Dental Health Service: aprospective 8 years follow up. Journal of Dentistry2013;41:297–306.

36. Lynch CD, Opdam NJ, Hickel R, Brunton PA, Gurgan S,

Kakaboura A, et al. Guidance on posterior resin composites:academy of operative dentistry – European Section. Journalof Dentistry 2014;42:377–83.

37. Horsted-Bindslev P, Bergenholtz G. Treatment of vital pulpconditions. In: Bergenholtz G, Horsted-Bindslev P, Reit C,editors. Textbook of endodontology.

2nd ed. London: Wiley-Blackwell; 2010. p. 47–69.

38. Bergenholtz G. Evidence for bacterial causation of adversepulpal responses in resin-based dental restorations. CriticalReviews in Oral Biology and Medicine 2000;11:467–80.

39. Mjo ¨ r IA. Pulp-dentin biology in restorative dentistry. Part 7:the exposed pulp. Quintessence International 2002;33:113–35.

40. Holmgren CJ, Lo EC, Hu D. Glass ionomer ART sealants inChinese school children-6-year results. Journal of Dentistry2013;41:764–70.

41. Murray PE, Hafez AA, Smith AJ, Cox CF. Bacterialmicroleakage and pulp inflammation associated withvarious restorative materials.Dental Materials 2002;18:470–8.

42. Desai S, Chandler N. The restoration of permanentimmature anterior teeth, root filled using MTA: a review. Journal of Dentistry 2009;37:652–7.

43. Cauwels RG, Lassila LV, Martens LC, Vallittu PK, VerbeeckRM. Fracture resistance of endodontically restored,weakened incisors. Dental Traumatology 2014. http://dx.doi.org/10.1111/edt.12103.

44. Cvek M. Prognosis of luxated non-vital maxillary incisorstreated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endodontics and DentalTraumatology 1992;8:45–55.


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