28 December 2022

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A new biomaterial for pulpotomy of permanent molars with immature apex

Simona Chirico

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The management of permanent teeth with incomplete apex with compromised exposed vital pulp is often a complex treatment with dubious results. These teeth can be treated with either direct pulp capping or pulpotomy. 

In the latter approach, the coronal pulp is amputated, and the root tissues are treated with a biomaterial to allow for full apical development. There are several biomaterials that can be used for this purpose, including mineral trioxide aggregate (MTA), which, despite its clinical efficacy, has drawbacks such as difficult management, a long setting time, tooth discoloration and high cost. 

These conditions prompted researchers to develop an alternative to the MTA. Potassium nitrate (KNO3) is a known desensitizer for hypersensitive teeth, but histopathological studies on animals have reported satisfactory results for its use also as a direct dental pulp capping material.

Materials and methods

In a study published in August 2021 in the Journal of Endodontics, Mohammed Ibrahim Ahmed and his team compared clinically and radiographically the effects of pulpotomies performed with polycarboxylate potassium nitrate versus those performed with mineral trioxide aggregate (MTA) in viable immature mandibular first molars. 

A total of 50 molars from 48 children aged six to nine years were included in the study. The impacted teeth were immature mandibular first molars with extensive caries that revealed pulp exposure during caries removal. Patients were randomly assigned equally into one of two groups:

• Group 1 in which potassium nitrate polycarboxylate was used as pulpotomy biomaterial (intervention group)
• Group 2 in which MTA was used as biomaterial for pulpotomy (control group).

Results

The treated teeth were definitively restored. The primary outcome was clinical or radiographic evaluation at one week, six months and 12 months. The secondary outcome was radiographic analysis at six and 12 months to determine dimensional changes during maturogenesis. The digital radiographs were imported into image processing software to take the measurements. Data were analyzed statistically with significance set at P .05.

Conclusions

From the data of this study, researchers concluded that potassium nitrate polycarboxylate may represent a valid biological and economical alternative to MTA as a pulpotomy agent in immature mandibular first molars.

For additional information

"Clinical and Radiographic Assessments of Potassium Nitrate in Polycarboxylate Versus Mineral Trioxide Aggregate as Pulpotomy Biomaterials in Immature Mandibular First Permanent Molars: A Randomized Clinical Trial."