| Compared with permanent teeth, primary teeth have lower degree of mineralization, weaker ability to acid-resisting and they have deeper fissures; as a result, primary teeth have a higher prevalence of caries. Coupled with children who like sweets and have weak ability of oral self-cleaning, deciduous caries are vulnerable to develop to deep caries in a short period of time. Primary molars whose roots are in a stable period when children are in their 3-8 years old undertake the main chewing function. When deep caries in primary molars occurs, the masticatory function decreases, then affects children’s nutritional intake, thereby affects the body growth and development. Therefore, it is important to select the appropriate method to treat deep caries primary teeth.Currently, indirect pulp capping is performed as a pulp treatment of asymptomatic deep caries primary teeth without pulp exposure. The pulp-capping procedures should be limited to small exposures(<1mm) during cavity preparation. I ndications of the treatment are clear. However, in the clinical work, it is more commonly seen the asymptomatic deep caries with mechanically pulp exposure; in this situation, it will be difficult for dentists to make appropriate choice of treatment options. As a result of the unique anatomical structure of the primary teeth and the physiological characteristics of children, it is often difficult to determine the extent of infectious coronal pulp. Therefore there lacks clear attitude for dentists on the treatment options on pulpotomy and pulpectomy in the daily clinical work. This study was to evaluate the clinical effect of pulpotomy and pulpectomy in deep caries treatment for primary teeth with exposed pulp. And this randomized clinical stud y was carried out to provide theoretical and clinical basis for deep caries treatment of deciduous teeth with pulp exposure.The main contents are as follows:1. A survey was carried out to investigate the choice on pulp therapy in mechanically pulp exposed primary teeth with deep caries among pediatric dentists, hoping to provide theoretical basis for clinical study of the treatment of such disease.2. The purpose of this randomized controlled trial was to compare the success rates of MTA pulpotomy and Vitapex pulpectomy in asymptomatic carious vital primary molars and provide guidelines to the clinical treatment.Methods1. Questionnaires were given out to 452 dentists from different cities from February to June in 2014. SPSS 18.0 was used for statistical analysis and Chi-square test was used to make it clear which factor would affect dentists’ choice.2. Children with one or more carious primary molars whose pulp would expose when the carious tissues were completely removed or the deep caries was close to the pulp in X-ray were included in the clinical trial under GA treatment in the Department of Pediatric Dentistry, School of Stomatology, Fourth Military Medical University from February to September, 2014. The molars were treated by 3 pediatric dentists and then immediately restored with a stainless steel crown cemented. All molars were received clinical and radiographical assessments at 6、12 and 18 months after treatment.Results1. Among the investigated 343 dentists, 131(38.19%)selected pulpotomy for mechanically pulp exposed primary teeth with deep caries while 212(61.81%)chose pulpectomy. Working experience and working place would affect the choice for dentists(P<0.05). For those who chose pulpotomy, 87.78% thought it could preserve the vitality of pulp to maintain a normal procedure of primary root resortption. For those who chose plupectomy, 172(81.13%)dentists considered it was difficult to judge the inflammatory condition of the pulp, thus the prognosis for pulpotomy was unfavorable.2. Fifty-eight molars(pulpotomy vs pulpectomy: 24 vs 34) missed following up in the investigation from two hundred and fifty teeth from one hundred and fift y- four children. One hundred and sixty-three teeth were judged as cure or effectively treated. Final clinical and radiographic success rate was 93.07% and 90.1% for MTA pulpotomy and 89.01% and 79.12% for Vitapex pulpectomy. There was statistical significant difference in success rates of pulpotomy and pulpectomy in the pulp treatment.Conclusions1. Due to subjective and objective limitations, pulpectomy was considered by more pediatric dentists when treating mechanically pulp exposed primary teeth with deep caries. More work was needed to promote the popularity for pulpotomy.2. MTA pulpotomy is effective to reserve the pulp in the pulp treatment of asymptomatic vital primary molars with pulp exposure. But at this stage of the economic conditions, high performance pulp capping drugs like MTA and rubber dam that can ensure the sterile environment cannot be obtained. While drug requirements of the pulpectomy are relatively low, but as a result of complexity of the root ca nal system, the survival rate of the primary teeth is low. |
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