PEDIATRIC ABSTRACTS
CLINICAL AND RADIOGRAPHIC OUTCOMES OF THE USE OF LOW-LEVEL LASER THERAPY IN VITAL PULP OF PRIMARY TEETH Fernandes AP, Lourenço Neto N, Teixeira Marques NC, Silveira Moretti AB, Sakai VT, Cruvinel Silva T, Andrade Moreira Machado MA, Marchini Oliveira T. Int J Paediatr Dent. 2015; 25(2):144-50
Dental caries is considered the most common chronic disease among children worldwide and is a major public health issue. If dental caries in primary teeth are not treated in a timely manner, children may have premature tooth loss, which may lead to space loss, poor esthetics, phonetics or functional occlusion. When caries lead to exposure of the coronal pulp of primary teeth, vital pulp therapy is performed while the radicular pulp is still healthy in attempt to preserve the tooth. Formocresol has historically been considered the gold standard material for pulpotomies for the past 60 years due to its ease of application, fixative ability, and bactericidal action. However, formocresol is known to have adverse effects including carcinogenicity, mutagenicity, and cytotoxicity. Low-level laser therapy (LLLT) is being researched as a new alternative pulp therapy treatment. LLLT exerts anti-inflammatory action by boosting collagen synthesis, reducing inflammatory exudation, and enhancing revascularization and epithelization. LLLT additionally provides pain relief and increases the pain threshold by increasing endorphins and decreasing bradykinin. However, there a few previous studies on the effects of LLLT on pulp therapy and more clinical trials are needed to determine if LLLT is an alternative to formocresol. The main purpose of this study was to compare clinical and radiographic success rates of LLLT and formocresol being used for pulpotomies on primary molar teeth. The study design was a split-mouth, randomized, controlled clinical trial. The study included 5-8-year olds with at least two bilateral carious primary molars that were indicated for pulpotomy. The
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children were well behaved with positive Frankl behavior and did not have any medical conditions that would contradict pulp therapy. The teeth that were selected had to have vital pulp tissue and restorable crowns. Any tooth with a fistula, pulp degeneration, swelling, pain or mobility were excluded. 50 children were screened and 36 of them met the criteria for a total of 106 teeth. The selected teeth were randomly selected for LLLT group or formocresol group. The same pediatric dentist who recruited the children performed all of the pulpotomies. Laser irradiation was set to manufacturer instructions and consisted of an irradiation time of 40 seconds rotated over the pulp stumps during application of each tooth. For the formocresol group, a cotton pellet soaked in 1:5 dilution of formocresol was placed on the pulp stumps for five minutes. The pulp chambers in each tooth of both groups was filled with zinc oxideeugenol and restored with a stainless steel crown. A postoperative radiograph was taken following completion of procedures. All children were recalled after 6-12 months for clinical and radiographic assessment. The 6 month follow up consisted of 51 teeth in each of the LLLT and formocresol groups available for both radiographic and clinical examination. Both groups had a 98 percent success rate following examination. Radiographic success rates were 100 percent for the LLLT group and 98 percent for the formocresol group. Ultimately, there was no significant difference between each of the groups. For the 12 month follow up 51 teeth were still available for radiographic and clinical examination. At the 12 month follow up there was no significant differences between the LLLT and formecresol groups, however, there was a decrease in
clinical success for both groups to 96.1 percent. Although the mechanism is not well known, LLLT has shown to be successful in multiple applications, including pulpotomy procedures. LLLT technology facilitates a devitalization reaction through biomodulation on dental pulp cell development, reactional dentin biostimulation, and a less-intense inflammatory process. When LLLT is applied to the dentin pulp interface following tooth preparation, there appears to be regeneration of dental structure, reduction in hypersensitivity to dentin, and elimination of pain caused by dental procedures. While formocresol has also shown to promote a similar devitalization cycle, there are unfavorable histological responses in the remaining radicular pulp when using formocresol and formocresol usually leads to premature exfoliation. Additional studies need to be performed in order to determine if LLLT has similar premature exfoliation of primary molars. Differences in outcomes of LLLT between studies has been shown to be attributed to differences in laser parameters. In the present study LLLT was used at 810nm wavelength, 4J energy, and 40 second application time under continuous mode. While LLLT showed successful results, this study’s findings do not support that LLLT is better than formocresol pulpotomies. Further studies are necessary with longer follow up periods of greater than 12 months and larger sample sizes are needed before LLLT can be definitively determined equivalent or more successful alternative to formocresol pulpotomies.
Dr. Andrew Crowell; VCU Pediatric Dentistry Resident
