Formocresol Pulpotomy: A Comprehensive Overview

 

Introduction

Formocresol pulpotomy is a widely used dental procedure aimed at preserving the vitality of primary teeth affected by caries or trauma. This technique involves the removal of the coronal portion of the dental pulp, followed by the application of formocresol to maintain the health of the remaining radicular pulp. Despite its long history of clinical success, the use of formocresol remains controversial due to concerns about its potential toxicity and long-term effects.

       Access opening to mandibular second deciduous molar

Procedure

The formocresol pulpotomy procedure typically involves the following steps:

1-Diagnosis : The tooth is diagnosed for pulpal involvement through clinical and radiographic examination.

2- Local anesthesia is administered, and the tooth is isolated using a rubber dam to prevent contamination.

3-Coronal Pulp Removal: The coronal portion of the pulp is surgically removed with excavator, leaving the radicular pulp intact.

4-Hemostasis: Hemostasis is achieved using a sterile cotton pellet moistened with saline or a hemostatic agent.

5-Application of Formocresol: A cotton pellet soaked in formocresol then squeeze it then placed over the radicular pulp stumps for a few minutes. Formocresol acts as a fixative, devitalizing the superficial pulp tissue and preserving the deeper radicular pulp.

6-Restoration: After the formocresol application, the tooth is restored with a suitable material, such as zinc oxide eugenol

• make thick mix of zinc oxide eugenol( the typical powder-to-liquid ratio for ZOE is 2:1) and put it with slight condensation to it with cotton pellet (cotton pellet must soaked in saline the squeeze it ) 
•  final restoration like glass ionomer then a stainless steel crown.

Advantages

Clinical Success: Formocresol has been used for decades with a high rate of clinical success in maintaining the function and vitality of primary teeth1.

Ease of Use: The procedure is relatively simple and can be performed quickly, making it a practical choice in pediatric dentistry.

Disadvantage

Toxicity: Formocresol contains formaldehyde, which is known for its  genotoxic potential. Concerns have been raised about the systemic absorption of formaldehyde and its long-term effects on children’s health.

Alternatives: Due to these concerns, alternative materials such as mineral trioxide aggregate (MTA) and biodentine have been explored. These materials offer biocompatibility and similar clinical success rates without the associated risks of formocresol.

                      Upper second deciduous molar

                      Lower first deciduous molar

 (A) Access opening of mandibular second molar after removal of dead pulp tissue. (B) Application of cotton pellet moistened with  formocresol (C) Application of reinforced zinc oxide eugenol (D) Stainless-steal crowns .

Periapical radiograph of mandibular first primary molar after pulpotomy

Conclusion

Formocresol pulpotomy remains a valuable procedure in pediatric dentistry, particularly for its simplicity and effectiveness. However, ongoing research and the development of safer alternatives are crucial to address the concerns associated with formocresol. Dentists must weigh the benefits and risks when choosing the appropriate treatment for their young patients.

For more information about class 1 snd class 11 preparation in primary teeth check this link:

https://oraloasis.blogspot.com/2024/10/steps-of-class-i-cavity-preparation-in.html

https://oraloasis.blogspot.com/2024/10/steps-for-class-ii-cavity-preparation.html

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC6611538/pdf/ijcpd-11-490.pdf

https://pmc.ncbi.nlm.nih.gov/articles/PMC4054056/

https://edj.journals.ekb.eg/article_73996_cc803b80ff6c1e3919632aff162ca4b2.pdf