Success of Biodentine and Ferric Sulfate as Pulpotomy Materials in Primary Molars: A Retrospective Study

Objective: To determine the clinical and radiographic success of Biodentine^® (BD) and Ferric Sulfate (FS) as primary molar pulpotomy materials and to compare their outcomes. Study design: Retrospective data was obtained from the electronic health records (EHR) of a university-based pediatric dental clinic. Participants were enrolled according to specified inclusion and exclusion criteria. Two trained and calibrated examiners evaluated the EHR using validated criteria for clinical and radiographic outcomes. Study data was numerically coded and analyzed. Cohen’s Kappa and Chi-square tests were used (p<0.05). Results: Eighty-three participants (62.7% females, age range two to eight years, average age of 4.5 years) with 102 pulpotomies were enrolled. FS was used in 78% (n=79) and BD in 22% (n=23) of the cases. Follow-up periods ranged from six to 36 months (mean of 17 months). BD showed 100% clinical and radiographic success, while FS demonstrated 84% clinical and 70% radiographic success. The two groups were compared at one year with no statistically significant differences. At 18 months, BD outperformed FS clinically (p=.012) and radiographically (p=.001). Intra-rater and inter-rater agreement were κ>0.88. Conclusions: Both materials can be recommended for clinical practice, however BD may be the preferred choice for its better outcomes at 18 months.

Biodentine; Ferric sulfate; Pulpotomy; Primary molar; Pediatric dentistry

1. Pulp Therapy for Primary and Immature Permanent Teeth. Pediatr Dent. Sep 15;39(6):325-333. 2017.

2. Coll JA, Seale NS, Vargas K, Marghalani AA, Al Shamali S, Graham L. Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-analysis. Pediatr Dent. Jan 15;39(1):16-123. 2017.

3. Ngan P, Alkire RG, Fields H. Management of Space Problems in the Primary and Mixed Dentitions. J Am Dent Assoc;130(9):1330-1339. 1999.

4. Fuks AB, Kupietzky A, Guelmann M. Pulp Therapy for the Primary Dentition. Pediatr Dent; January:329-351. 2019.

5. Ranly DM. Pulpotomy therapy in primary teeth: new modalities for old rationales. Pediatr Dent;16(6):403-409.1994.

6. Srinivasan V, Patchett CL, Waterhouse PJ. Is there life after Buckley’s Formocresol? Part I–a narrative review of alternative interventions and materials. Int J Paediatr Dent; 16(2):117-27.2006.

7. International Agency for Research on Cancer. Press release no. 153. 15 June 2004. Available at http://www.iarc.fr/pageroot/PRELEASES/ pr153a.html. Accessed August 28, 2020.

8. Landau MJ, Johnsen DC. Pulpal responses to ferric sulfate in monkeys. J Dent Res; 67:215.1988.

9. Lemon RR, Steele PJ, Jeansonne BG. Ferric sulfate hemostasis: effect on osseous wound healing. Left in situ for maximum exposure. J Endod;19(4):170-173.1993.

10. Bandi M, Mallineni SK, Nuvvula S. Clinical applications of ferric sulfate in dentistry: A narrative review. J Conserv Dent;20(4):278-281.2017.

11. About I. Biodentine: from biochemical and bioactive properties to clinical applications. G Ital Endod;30(2):81-88. 2016.

12. Mohamed S, Alamoudi NM, Meligy OAES El. Clinical Applications of Biodentine in Pediatric Dentistry: A Review of Literature. J Oral Hyg Heal;03(03):1-6. 2015.

13. Zanini M, Sautier JM, Berdal A, Simon S. Biodentine Induces Immortalized Murine Pulp Cell Differentiation into Odontoblast-like Cells and Stimulates Biomineralization. J Endod;38(9):1220-1226. 2012.

14. Rajasekharan S, Martens LC, Vandenbulcke J, Jacquet W, Bottenberg P, Cauwels RGEC. Efficacy of three different pulpotomy agents in primary molars: a randomized control trial. Int Endod J;50(3):215-228.2017.

15. Bossù M, Iaculli F, Di Giorgio G, Salucci A, Polimeni A, Di Carlo S. Different Pulp Dressing Materials for the Pulpotomy of Primary Teeth: A Systematic Review of the Literature. J Clin Med. Mar 19;9(3). 2020.

16. Priyalakshmi S, Manish R. Review on Biodentine: A bioactive dentin substitute. IOSRJ Dent Med Sci 2014;13(1):13-7.

17. Waterhouse PJ, Nunn JH, Whitworth JM. An investigation of the relative efficacy of Buckley’s Formocresol and calcium hydroxide in primary molar vital pulp therapy. Br Dent JJan 8;188(1):32-6. 2000.

18. Subramaniam P, Konde S, Mathew S, Sugnani S. Mineral trioxide aggregate as pulp capping agent for primary teeth pulpotomy: 2 year follow up study. J Clin Pediatr Dent. Summer;33(4):311-4. 2009.

19. El Meligy OAES, Alamoudi NM, Allazzam SM, El-Housseiny AAM. BiodentineTM versus formocresol pulpotomy technique in primary molars: a 12-month randomized controlled clinical trial. BMC Oral Health;19(1):3. 2019.

20. Sirohi K, Marwaha M, Gupta A, Bansal K, Srivastava A. Comparison of Clinical and Radiographic Success Rates of Pulpotomy in Primary Molars using Ferric Sulfate and Bioactive Tricalcium Silicate Cement: An in vivo Study. Int J Clin Pediatr Dent;10(2):147-151. 2017.

21. Havale R, Anegundi RT, Indushekar K, Sudha P. Clinical and radiographic evaluation of pulpotomies in primary molars with formocresol, glutaraldehyde and ferric sulphate. Oral Health Dent Manag;12(1):24-31.2013.

22. Odabaş ME, Alaçam A, Sillelioğlu H, Deveci C. Clinical and radiographic success rates of mineral trioxide aggregate and ferric sulphate pulpotomies performed by dental students. Eur J Paediatr Dent;13(2):118-122.2012.

23. Mittal S, Kumar T, Mittal S, Sharma J. “Internal root resorption: An endodontic challenge”: A case series. J Conserv Dent.Nov;17(6):590-3. 2014.