The Clinical, Radiographic and Histological evaluation of three different concentrations of Formocresol as a pulpotomy agent

Abstract

Background: Formocresol, though the center of much controversy is still the most widely used medicament for primary teeth pulpotomy and an intracanal medicament which has undergone a lengthy evolution to shorten the formocresol application time and reduce the concentration of formocresol exposure to the pulp tissue. Hence, the determination of the actual effective dose and concentration of formocresol for clinical application in primary teeth is an important area of research and a thorough clinical, radiographic and histological investigation in human subjects is very much needed.

Materials & methods: The study was conducted on 45 primary molars for the Clinical, Radiographic study and 45 premolars orthodontically indicated for extraction for the Histological study. The samples were randomly and equally divided into 3 groups of 15 each for pulpotomy with full strength formocresol, 1:5 diluted formocresol and 1:25 diluted formocresol respectively. The pulpotomized primary molars were clinically evaluated at 1st, 3rd, 6th and 9th month while the pulpotomized premolars were subjected for histological evaluation after extraction.

Results: Obtained by chi-square test revealed that all the pulpotomized primary molars were asymptomatic till the end of the study period; suggesting 100% clinical and radiographic success while histologically, the three concentrations of formocresol showed decreased severity of fixation of the pulp tissue with decreasing concentration of formocresol.

Conclusion: It can be inferred that the diluted formulations (1:5 and 1:25) of formocresol are equally efficient when compared to full-strength formocresol and thus, can be recommended for pulpotomy in primary teeth. How to cite the article: Goyal S, Abuwala T, Joshi K, Mehta J, Indushekar KR, Hallikerimath S. The Clinical, Radiographic and Histological evaluation of three different concentrations of Formocresol as a pulpotomy agent. J Int Oral Health 2014;6(2):118-25.

Keywords: Dilute formocresol; formocresol; primary teeth; pulpotomy.

Figure 1: Intraoral findings in the case selected for pulpotomy showing caries with 84.

Figure 2: IOPA of 84 showing radiolucency in distal side involving enamel, dentin and approximating the distal pulp horn.

Figure 3: Postoperative photograph showing stainless steel crown with 84 after the pulpotomy procedure.

Figure 4: IOPA showing the stainless steel crown restoration and pulpotomy with 84.

Figure 5: IOPA with 84 after 1 month.

Figure 6: IOPA with 84 after 3 months.

Figure 7: IOPA with 84 after 6 months.

Figure 8: IOPA with 84 after 9 months.

Figure 9: Extracted pulpotomized premolar, decalcified, mounted on paraffin block, sectioned and stained.

Figure 10: Pulp tissue treated with full strength formocresol (HandE, 10 X) shows severe fibrosis (hyalinization) of collagen fibers.

Figure 11: Pulp tissue reaction with 1:5 diluted formocresol (Group B) [HandE, 4X] shows fibrocellular stroma with dilated blood vessels.

Figure 12: Pulp tissue reaction to 1:25 diluted formocresol (Group C) [HandE, 4X] shows increased number of fibroblasts (hypercellular stroma) in the stromal tissue.

Figure 13: Histology of the decalcified tooth section showing the entire pulp tissue (HandE, 4X).