Original Article

A Randomized Controlled Clinical Trial Comparing Clinical and Radiographic Success Rates of MTA and rhBMP2 in Pulpotomy of Primary Teeth

Abstract

Objectives: In an ideal pulpotomy, the radicular pulp remains vital, healthy, and fully encased within an odontoblastic layer. Mineral trioxide aggregate (MTA) and bone morphogenetic proteins (BMPs) have been suggested to facilitate this outcome. We aimed to compare the clinical and radiographic failure and success rates of MTA and rhBMP2 as pulpotomy medicaments.

Materials and Methods: Sixty-eight teeth from 3–6-year-old children were randomly assigned to two groups using a split-mouth design. Cervical pulpotomy was performed using MTA in one group and rhBMP2 in the other. Subsequently, the teeth were restored with stainless-steel crowns. Clinical and radiographic assessments were performed at 3, 6, 9, and 12-month follow-up intervals to evaluate success and failure rates. Data were analyzed using Chi-square test and Kaplan-Meier survival analysis (P<0.05)

Results: At six and nine months, one tooth in the BMP2 group and one tooth in the MTA group showed internal resorption, respectively. After 12 months, one tooth in the BMP2 group exhibited PDL widening. The radiographic success rate was 100% for the MTA- and 97.1% for the BMP2-group at six months, 96.7% for both groups at nine months, and 96.7% and 93.3%, respectively, at 12 months. No clinical failure criteria were observed in any of the teeth. Survival analysis revealed no significant difference between the two groups.

Conclusion: The study reveals comparable outcomes between rhBMP2 and MTA, suggesting rhBMP2 as a viable alternative for pulpotomy in primary teeth. With minimal incidences of complications and no significant differences noted, rhBMP2 demonstrates potential for clinical use.

1. Fuks A. Current concepts in vital primary pulp therapy. Eur J Pediatr Dent. 2002;3(3):115-20.
2. Kumar Praveen N, Rashmi N, Bhaskar Vipin K. Pulpotomy Medicaments: Continued Search for New Alternatives-A Review. OHDM 2014;13(4):883-90.
3. Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod. 1999;25(3):197-205.
4. Osorio RM, Hefti A, Vertucci FJ, Shawley AL. Cytotoxicity of endodontic materials. J Endod. 1998;24(2):91-6.
5. Torabinejad M, Hong C-U, Ford TRP, Kariyawasam SP. Tissue reaction to implanted super-EBA and mineral trioxide aggregate in the mandible of guinea pigs: a preliminary report. J Endod. 1995;21(11):569-71.
6. Torabinejad M, Hong C, McDonald F, Ford TP. Physical and chemical properties of a new root-end filling material. J Endod. 1995;21(7):349-53.
7. Thesleff I, Sharpe P. Signalling networks regulating dental development. Mech Dev. 1997;67(2):111-23.
8. Hogan BL. Bone morphogenetic proteins in development. Curr Opin Genet Dev. 1996;6(4):432-8.
9. Lyons KM, Pelton RW, Hogan B. Organogenesis and pattern formation in the mouse: RNA distribution patterns suggest a role for bone morphogenetic protein-2A (BMP-2A) Development. 1990;109(4):833-44.
10. Rutherford B, Fitzgerald M. A new biological approach to vital pulp therapy. Crit Rev Oral Biol Med. 1995;6(3):218-29.
11. Gronthos S, Mankani M, Brahim J, Robey PG, Shi S. Postnatal human dental pulp stem cells (DPSCs) in vitro and in vivo. Proc Natl Acad Scie. 2000;97(25):13625-30.
12. Jepsen S, Albers H-K, Fleiner B, Tucker M, Rueger D. Recombinant human osteogenic protein-1 induces dentin formation: an experimental study in miniature swine. J Endod. 1997;23(6):378-82.
13. Nakashima M. Induction of dentin formation on canine amputated pulp by recombinant human bone morphogenetic proteins (BMP)-2 and-4. J Den Res.1994;73(9):1515-22.
14. Rutherford RB, Wahle J, Tucker M, Rueger D, Charette M. Induction of reparative dentine formation in monkeys by recombinant human osteogenic protein-1. Arch Oral Biol. 1993;38(7):571-6.
15. Bengtson AL, Bengtson NG, Bengtson CRG, Pinheiro SL, Guedes-Pinto AC. Pulpotomy in human deciduous teeth and bone morphogenetic protein (rhBMP-2). Arch Oral Res. 2017;4(3).
16. Schröder U. Effects of calcium hydroxide-containing pulp-capping agents on pulp cell migration, proliferation, and differentiation. J Den Res. 1985;64(4):541-8.
17. Tziafas D. The future role of a molecular approach to pulp-dentinal regeneration. Caries Res. 2004;38(3):314-20.
18. Peng L, Ye L, Tan H, Zhou X. Evaluation of the formocresol versus mineral trioxide aggregate primary molar pulpotomy: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(6):e40-e4.
19. Abedi H, Torabinejad M, Pitt Ford T, Bakland L. The use of mineral trioxide aggregate cement (MTA) as a direct pulp capping agent. J Endod. 1996;22(4):199.
20. Faraco IM, Holland R. Response of the pulp of dogs to capping with mineral trioxide aggregate or a calcium hydroxide cement. Dent Traumatol. 2001;17(4):163-6.
21. Shirvani A, Asgary S. Mineral trioxide aggregate versus formocresol pulpotomy: a systematic review and meta-analysis of randomized clinical trials. Clin Oral Investig. 2014;18(4):1023-30.
22. Holan G, Eidelman E, Fuks AB. Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol. Pediatr Dent. 2005;27(2):129-36.
23. Yildiz E, Tosun G. Evaluation of formocresol, calcium hydroxide, ferric sulfate, and MTA primary molar pulpotomies. Eur J Dent. 2014;8(2):234.
24. Agamy HA, Bakry NS, Mounir MM, Avery DR. Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth. Pediatr Dent. 2004;26(4):302-9.
25. Ranly D, Garcia-Godoy F. Current and potential pulp therapies for primary and young permanent teeth. Journal of Dentistry. 2000;28(3):153-61.
26. Rutherford RB, Gu K. Treatment of inflamed ferret dental pulps with recombinant bone morphogenetic protein‐7. Eur J Oral Sci. 2000;108(3):202-6.
27. Rutherford RB, Spångberg L, Tucker M, Rueger D, Charette M. The time-course of the induction of reparative dentine formation in monkeys by recombinant human osteogenic protein-1. Arch Oral Biol. 1994;39(10):833-8.
28. Wedenberg C, Zetterqvist L. Internal resorption in human teeth—a histological, scanning electron microscopic, and enzyme histochemical study. J Endod. 1987;13(6):255-9.
29. Smith NL, Seale NS, Nunn ME. Ferric sulfate pulpotomy in primary molars: a retrospective study. Pediatr Dent. 2000;22(3):192-9.
IssueVol 21 (Continuously Published Article-Based) QRcode
SectionOriginal Article
DOI https://doi.org/10.18502/fid.v21i12.15224
Keywords
Pulpotomy Bone Morphogenetic Proteins Mineral Trioxide Aggregate Tooth Deciduous
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How to Cite
1.
Nourbakhsh N, Ziaei S, Panahi H, Sedaghat N, Behnia A. A Randomized Controlled Clinical Trial Comparing Clinical and Radiographic Success Rates of MTA and rhBMP2 in Pulpotomy of Primary Teeth. Front Dent. 2024;21.