Clinical, Radiographic and Patient Acceptance Evaluation of LASER Compared to Formocresol Pulpotomies inPrimary Molars
Condition: Pulpitis Reversible
MeSH terms: Pulpitis
Study type: Interventional

Summary: 
      The goal of this clinical trial was to compare the clinical and radiographic success of laser
      versus formocresol pulpotomy in primary molars. The main questions it aimed to answer was:

      • Does laser pulpotomy has higher clinical and radiographic success rate as formocresol
      pulpotomy in primary molars?

      Participants were selected according to eligibility criteria to undergo pulpotomy for their
      lower primary molars under local anesthesia using one of the following techniques:

        -  Group 1: Formocresol

        -  Group 2: Diode laser Group 3: Er:CrYSGG laser Clinical and radiographic follow up were
           performed for 18 months
    

Detailed description: 
      In all teeth, local anaesthesia was administered using 7.0 mg/kg 4% articane + 1: 100,000
      epinephrine (with a maximum total dosage of 500 mg)

      - Rubber dam isolation was done.

      Access cavity preparation:

        -  In all groups, caries removal was done with a sterile #330 high-speed bur, and coronal
           access cavity preparation was done with a sterile #4 high-speed round bur using high
           speed hand piece and water coolant. The access cavity was then refined using a sterile
           high-speed fissure bur. LASER operating parameters: Figure (10)

             -  Wavelength: 2780 nm

             -  Repetition rate: 15 Hz

             -  Water spray: 80

             -  Air : 60

             -  Emission mode: Free-running pulsed

             -  Tip: MZ 10- 6 mm, Zip Tip

             -  Average power: 8 Watt The coronal pulp was amputated by a sterile sharp excavator,
                the amputated sites were rinsed with water. Hemorrhage was controlled by placing
                sterile, saline- wetted cotton pellets on the radicular pulp stumps under slight
                pressure (Thompson et al., 2001) for 5 min for primary hemostasis ( J Dent Res
                84(12) 2005). At this stage, the achievement of complete hemostasis was an
                inclusion criterion. If bleeding recommenced afterwards, partial pulpectomy was
                performed and the tooth was excluded from the study.

        -  After achieving complete haemostasis pulp stumps were treated according to each group:
           Group1: (control group)

        -  A cotton pellet that was moistened with 1:5 diluted bottle of FC (Formacresol, PREVEST
           DenPro, Digiana, Jammu, India) was placed over the pulp stumps for 5 minutes. After
           removal of the cotton, the fixed pulp stumps were capped with reinforced zinc oxide and
           eugenol base (Zinconol, PREVEST DenPro, Digiana, Jammu, India). Group2: (Diode LASER
           group)

        -  All patients, parents and clinical staff were requested to wear appropriate eye
           protection goggles during laser application, Figure (12). After achieving hemostasis,
           pulp stumps was treated with Diode LASER (980 nm).If hemostasis was not achieved, the
           process was repeated one more time until adequate hemostasis was achieved, Figure (15,
           16). Diode LASER radiation (wavelength 980 nm) was delivered to the canal orifices with
           a special handpiece and fiber glass of 200 μm diameter, Figure (13), the parameters were
           set at: Figure (14) Emission mode: Pulsed contact mode Time: 2 seconds. Power: 2 Watt
           power with average power of 1 Watt and total energy of one spot, corresponding to two
           minutes and 31 seconds exposure was 4.0 J/cm 2. Group3: (Erbium:Chromium,YSGG LASER
           group) Pulp tissues in this group were treated with Erbium:Chromium,YSGG LASER (2780
           nμ). (Waterlase Biolase®, Biolase, Inc., San Clemente, California, USA) Once the pulp
           chamber was opened, the laser tip was placed into the pulp chamber using for
           approximately 15 seconds. In most instances, this was repeated three times. If
           hemostasis was not achieved, the process was repeated one more time until adequate
           hemostasis was achieved. Er: Cr, YSGG LASER radiation (wavelength 2780 nμ) was delivered
           with a special handpiece, and a tip: MZ 10- 6 mm, Zip Tip, to the canal orifices.

      LASER operating parameters:

        -  Wavelength: 2780 nm

        -  Repetition rate: 50 Hz

        -  Water spray: 1

        -  Air : 20

        -  Emission mode: Free-running pulsed In all groups, reinforced zinc oxide eugenol cement
           was placed over the pulp stumps, and the tooth was restored with a stainless steel
           crown. Preoperative and postoperative as well as follow up periapical radiographs at 6,
           12 and18 months were obtained by standardized paralleling technique and exposure time of
           0.25 seconds. An XCP film holder (Super Bite, Hawe Neos DentalSA, Switzerland) was used.
           Digital radiographs were obtained and scanned using size 0 phosphostimulable phosphor
           plates [X mind AC (de Gotzen, Italy) and Fona-Scaneo, phosphor plate scanner,
           respectively.
    

Intervention name(s): Diode laser; Er:CrYSGG; Formocresol
Intervention type(s): Procedure; Procedure; Procedure
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Pulp, vital pulp therapy, pulpotomy, formocresol, diode, erbium