Pulpectomy in primary molars: little difference with 3 filing materials

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Pulp treatments are required to manage extensive tooth decay, which remains a significant problem in children. Pulp capping, pulpotomy and pulpectomy are three techniques dependent of the severity of disease. Although pulpectomy in primary molars is controversial because of root morphology, root resorption and proximity of the permanent successors. The aim of this study was to evaluate the outcome of root canal treatment in primary teeth using three root canal filling materials – RC Fill, Vitapex and Pulpdent root canal sealer.

Methods

Primary molars in children aged between 4- 9 years requiring pulpectomy were randomised to receive RC Fill [zinc oxide-eugenol (ZOE) with iodoform]- Group 1; Vitapex (calcium hydroxide with iodoform) – Group II or Pulpdent root canal sealer (ZOE) – Group III. Treatment was carried out under rubber dam and local anaesthesia using a standard approach with filing material being mixed according to manufacturers instruction. The pulp chamber was filled with a class ionomer and tooth restored with a stainless steel crown at the same visit. Outcomes were measured clinically and radiographically at 6, 12 and 30 months by examiners blind to treatments.

Results

129 teeth in 88 patients were randomised.
90 teeth were available for follow up at 30 months.
There was no significant difference in the success rate for the 3 filing materials.
The percentage success rates in those teeth available for examination at 30 months were 94%, 90% and 97% for RC Fill, Vitapex and Pulpdent, respectively

	Number of teeth examined	RC Fill	Vitapex	Pulpdent
Baseline	129	43	43	43
Success at 30 months	90	29	26	29

Conclusions

The authors concluded:

All three materials, RC Fill, Vitapex and Pulpdent, were equally effective root filling materials for primary molars with necrotic pulps and irreversible pulpitis at 30 months. However, long-term follow-up until the eruption of the successor teeth is needed for more definitive assessments.

Comments

The unit of randomisation for this trial is the tooth rather than the patient. The power calculation indicated that 37 teeth per group would be required and at 30 months there was a 30% drop in the number of teeth available for assessment. The authors report a success rate of 94%, 90% and 97% for RC Fill, Vitapex and Pulpdent, respectively at 30 months in those 90 teeth available for assessment. However, if you assume that all those teeth that were not available for assessment failed, the success rate would be 67.4%, 60.4% and 67.4% respectively.

The recent Cochrane review by Smaïl-Faugeron et al (Dental Elf – 14^th Aug 2014) included 8 trials comparing different medicaments for pulpectomy and 2 trials comparing pulpotomy with pulpectomy. The quality of the evidence was low but there was a suggestion that Vitapex may yield better results that zinc oxide and eugenol pastes.