Fracture resistance of primary molars after pulpotomy procedure using mineral trioxide aggregate or Biodentine

In this study, the effect of mineral trioxide aggregate (MTA) and Biodentine on the resistance to fracture of pulpotomized primary molars was evaluated. 75 primary molars were divided into 2 control groups (positive and negative) and 3 experimental groups with 15 teeth each. No treatment was applied to the teeth in the negative control group. In the teeth in the positive control group, pulpotomy cavities were performed, but not filled. In the teeth in the experimental group, pulpotomy cavities were performed, and filled as follows. Group 3: mineral trioxide aggregate + glass ionomer cement (GIC); Group 4: Biodentine + GIC and Group 5: zinc oxide-eugenol + GIC. Final restorations in teeth in all experimental groups were completed with composite filling material. 75 teeth were then subjected to fracture resistance testing. Obtained data were analyzed statistically. Sorting by fracture resistance; Group1 > Group 4 > Group 3 = Group 5 > Group 2 (p < 0.05). Restorable fracture type was predominant in experimental groups (p < 0.05). The use of Biodentine in teeth undergoing pulpotomy in primary teeth can be preferred as a suitable base material to increase resistance to fracture.

Biodentine; MTA; Primary teeth; Pulpotomy

[1] Boutsiouki C, Frankenberger R, Krämer N. Clinical and radiographic success of (partial) pulpotomy and pulpectomy in primary teeth: a systematic review. European Journal of Paediatric Dentistry. 2021; 22: 273–285.

[2] Nadelman P, Bedran N, Magno MB, Masterson D, de Castro ACR, Maia LC. Premature loss of primary anterior teeth and its consequences to primary dental arch and speech pattern: a systematic review and meta-analysis. International Journal of Paediatric Dentistry. 2020; 30: 687–712.

[3] Noueiri B, Nasrallah H. Biodentine™ pulpotomy in stage I primary molars: a 12-month follow-up. International Journal of Clinical Pediatric Dentistry. 2023; 15: 660–666.

[4] Vilella-Pastor S, Sáez S, Veloso A, Guinot-Jimeno F, Mercadé M. Long-term evaluation of primary teeth molar pulpotomies with Biodentine and MTA: a CONSORT randomized clinical trial. European Archives of Paediatric Dentistry. 2021; 22: 685–692.

[5] Fuks AB. Pulp therapy for the primary and young permanent dentitions. Dental Clinics of North America. 2000; 44: 571–596.

[6] Alamoudi N, Nadhreen A, Sabbagh H, El Meligy O, Al Tuwirqi A, Elkhodary H. Clinical and radiographic success of low-level laser therapy compared with formocresol pulpotomy treatment in primary molars. Pediatric Dentistry. 2020; 42: 359–366.

[7] Gizani S, Seremidi K, Stratigaki E, Tong HJ, Duggal M, Kloukos D. Vital pulp therapy in primary teeth with deep caries: an umbrella review. Pediatric Dentistry. 2021; 43: 426–437.

[8] Kim CH, Bae JS, Kim I, Song JS, Choi H, Kang C. Prognostic factors for the survival of primary molars following pulpotomy with mineral trioxide aggregate: a retrospective cohort study. Clinical Oral Investigations. 2021; 25: 1797–1804.

[9] Thomas J, Bhat S, Prabha AA, Harris A, Rinu K, Mohan A. Comparative evaluation of microleakage of various restorative materials in pulpotomized primary molars—in vitro study. Journal of Pharmacy and Bioallied Sciences. 2022; 14: 78.

[10] Vanishree H, Shanthala B, Bobby W. The comparative evaluation of fracture resistance and microleakage in bonded amalgam, amalgam, and composite resins in primary molars. Indian Journal of Dental Research. 2015; 26: 446.

[11] Killi N, Chak RK, Singh RK, Mutyala J. Clinical radiographic evaluation of 3Mixtatin and MTA in primary teeth pulpotomies: a randomized controlled. International Journal of Clinical Pediatric Dentistry. 2022; 15: S80–S86.

[12] Guo J, Zhang N, Cheng Y. Comparative efficacy of medicaments or techniques for pulpotomy of primary molars: a network meta-analysis. Clinical Oral Investigations. 2023; 27: 91–104.

[13] Sanjari K, Ghajari M, Ghasemi A, Moradi A. Fracture resistance of pulpotomized and composite-restored primary molars: incremental versus bulk-fill techniques. Dental Research Journal. 2020; 17: 412.

[14] Santosh SS, Ballal S, Natanasabapathy V. Influence of minimally invasive access cavity designs on the fracture resistance of endodontically treated mandibular molars subjected to thermocycling and dynamic loading. Journal of Endodontics. 2021; 47: 1496–1500.

[15] Pattanaik S, Mohammad N, Reddy TB, Animireddy D, Ankireddy S. Comparative evaluation of the fracture strength of pulpotomized primary molars: an in vitro study. International Journal of Clinical Pediatric Dentistry. 2019; 12: 5–9.

[16] Jafarpour S, El-Badrawy W, Jazi H, McComb D. Effect of composite insertion technique on cuspal deflection using an in vitro simulation model. Operative Dentistry. 2012; 37: 299–305.

[17] el-Kalla IH, García-Godoy F. Fracture strength of adhesively restored pulpotomized primary molars. ASDC Journal of Dentistry for Children. 1999; 66: 238–242.

[18] Roghanizad N, Jones J. Evaluation of coronal microleakage after endodontic treatment. Journal of Endodontics. 1996; 22: 471–473.

[19] Nagas E, Cehreli ZC, Uyanik O, Vallittu PK, Lassila LVJ. Reinforcing effect of glass fiber—incorporated ProRoot MTA and Biodentine as intraorifice barriers. Journal of Endodontics. 2016; 42: 1673–1676.

[20] Nagas E, Uyanik O, Altundasar E, Durmaz V, Cehreli ZC, Vallittu PK,

et al. Effect of different intraorifice barriers on the fracture resistance of roots obturated with resilon or gutta-percha. Journal of Endodontics. 2010; 36: 1061–1063.

[21] Ghahramani Y, Shafiei F, Jowkar Z, Kazemian S. The effects of various restorative techniques on the fracture resistance of pulpotomized permanent premolars. International Journal of Dentistry. 2021; 2021: 1–7.

[22] Ausiello P, De Gee AJ, Rengo S, Davidson CL. Fracture resistance of endodontically-treated premolars adhesively restored. American Journal of Dentistry. 1997; 10: 237–241.

[23] Fennis WM, Kuijs RH, Kreulen CM, Verdonschot N, Creugers NH. Fatigue resistance of teeth restored with cuspal-coverage composite restorations. The International Journal of Prosthodontics. 2004; 17: 313–317.

[24] Kim N, Kim H, Kim IH, Lee J, Lee KE, Lee HS, et al. Novel 3d printed resin crowns for primary molars: in vitro study of fracture resistance, biaxial flexural strength, and dynamic mechanical analysis. Children. 2022; 22: 1445.

[25] Singhal Y, Srivastava N, Rana V, Kaushik N, Reddy V. Efficacy of root canal ınstrumentation and fracture strength assessment in primary molars after preparing two different shapes of access cavity: an ex vivo histological study. International Journal of Clinical Pediatric Dentistry. 2021; 14: 518–524.

[26] Guneser MB, Akbulut MB, Eldeniz AU. Effect of various endodontic irrigants on the push-out bond strength of Biodentine and conventional root perforation repair materials. Journal of Endodontics. 2013; 39: 380–384.

[27] Al-Sherbiny IM, Farid MH, Abu-Seida AM, Motawea IT, Bastawy HA. Chemico-physical and mechanical evaluation of three calcium silicate-based pulp capping materials. The Saudi Dental Journal. 2021; 33: 207–214.

[28] Butt N, Bali A, Talwar S, Chaudhry S, Nawal R, Yadav S. Comparison of physical and mechanical properties of mineral trioxide aggregate and Biodentine. Indian Journal of Dental Research. 2014; 25: 692.

[29] Saghiri M, Garcia-Godoy F, Asatourian A, Lotfi M, Banava S, Khezri-Boukani K. Effect of pH on compressive strength of some modification of mineral trioxide aggregate. Medicina Oral Patología Oral Y Cirugia Bucal. 2013; 18: e714–e720.