Clinical Evaluations

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case for deciduous teeth which have remained in place until their “natural” elimination. It should be noted that some 30% of generally uncrowned temporary teeth, fracture during mastication and have to be extracted by the practioner. In this case, treatment by Pulpotec is, obviously, not at fault. 5.2) Permanent teeth : a) The 310 cases X-rayed present a healthy physiological image with no trace of periapical infection in the second X-ray, added to which, these teeth were not painful and mastication was perfectly normal. During the same period of 13 years, 61 permanent teeth had to undergo further treatment by total pulpectomy. It seems logical to be able to compare these two figures. Effectively, in both cases, it is impossible to follow all the patients treated. This suggests a success rate of 80%, a figure which also corresponds to that quoted by Professor A. Marmasse in his work (7). b) Undesirable side-effects : Following utilization of Pulpotec, 3 types of undesirable side-effects have been noticed : > In 15% of the cases of teeth treated, a more or less intense pain of an arthritic type was felt during the days which followed the treatment. It lessened progressively on its own or with the help of anti-inflammatory medication taken orally to speed up the process. > In 3% of the cases of teeth treated, pain of medium intensity (also quoted by Professor Marmasse) was felt until the second session 8 days later. This was treated by the immediate removal of the Pulpotec from the pulpal chamber, followed by the placement of a new dose of Pulpotec. Pain ceased immediately in each case. > Exceptionally (2 cases in this study) pain of high intensity can occur. This was due to the fracture of a tooth which had not been detected during the initial examination or to the perforation of the floor of the pulpal chamber which had also been overlooked. In such cases the tooth most often has to be extracted which is precisely the same consequence which would have prevailed following treatment by pulpectomy. 6. Discussion and conclusions : Obviously, it is difficult to expect that X-rays and a clinical follow-up alone will prove the perenniality of pulpal vitality after treatment with Pulpotec. Proof of this type, stated by Dr Marmasse to be very difficult to establish after vital pulpotomy (7), has not been included in these clinical trials for both ethical and practical reasons. On the other hand, post-operative functional tests, as well as the X-rays, appear to confirm the perenniality of pulpal vitality after treatment with Pulpotec.
This is further confirmed by the fact that the follow-up of immature permanent molars treated with Pulpotec, has indicated normal, progressive radicular edification until complete maturity. Finally, if one considers that, on the one hand, in addition to the important risks linked to periapex, the further risks linked to pulpectomy are (with the exception of point N° 2) identical to those linked to pulpotomy, that is to say essentially pain of an arthritic type and, on the other hand, the percentage of clinical failure is significantly higher for pulpectomy than for pulpotomy (50% versus 20%), it would seem sensible to prefer this technique. All the more so as it grants an additional span of life for the tooth and simplifies the work of the dental surgeon. As a result, it can be considered more reliable and likely to optimize the chances of survival for the teeth treated by pulpotomy with Pulpotec. The investigator : Dr J. B. Dental-surgeon Bibliography 1. L’information Dentaire N° 44 of 19 December 1996-3535 article entitled “Restarting treatment in endodontics” 2. L’information Dentaire N° 33 of 28 September 1995 (work by Hess-1925-, De Deus - 1975- and Vertucci - 1984 -) 3. Actualités odonto-stomatologiques N° 192 December 1995 - 563 - 4. L’information dentaire N° 25 of 22nd June 1972, Article by Pr Commissionnat : «The flow-back in the lower dental canal of filling substances constitutes a major urgencyin our specialty» 5. L’information Dentaire N° 40 of 21 November 1996 Article by Claude Aaron and Yves Commissionnat 6. Swedish Dental Journal supplement 39, 1986 : Dental Pulp Inflammation, experimental studies in human and monkey teeth by Johan Warfvinge 7. Dentisterie Opératoire, Volume 1, Dentisterie Thérapeutique, Professor A. Marmasse 1969 8. Hess J.C., Medioni E. et Vene G. : “ Thérapeutique endodontique. Ensemble pulpo-dentinaire. Pulpotomie ” - Editions techniques – Encycl. Méd. Chir. (Paris-France) Odontologie 23035 D18, 2 –1990.
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Page 11: S. Minosyan, 50 y.o. The 48th tooth

Clinical Evaluations

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