Space Maintenance in the Primary Dentition










348 Part 3 The Primary Dentition Years: Three to Six Years
61. Motta LJ, Bussadori SK, Campanelli AP, et al. Randomized controlled
clinical trial of long-term chemo-mechanical caries removal using
Papacarie gel. J Appl Oral Sci. 2014;22:307–313.
62. Bjørndal L, Darnnavan T. A light microscopic study of odontoblastic
and non-odontoblastic cells involved in tertiary dentinogenesis in
well-dened cavitated carious lesions. Caries Res. 1999;33:50–60.
63. Ferracane JL, Cooper PR, Smith AJ. Can Interaction of materials
with the dentin-pulp complex contribute to dentin regeneration?
Odontology. 2010;98:2–14.
64. Kanca J III. Replacement of a fractured incisor fragment over pulpal
exposure: a case-report. Quintessence Int. 1993;24:81–84.
65. Casagrande L, Falster CA, Di Hipolito V, et al. Eect of adhesive
restorations over incomplete dentin caries removal: 5-year follow-up
study in primary teeth. J Dent Child (Chic). 2009;76:117–122.
66. Nakajima M, Sano H, Burrow MF, et al. Bonding to caries aected
dentin. J Dent Res (special issue). 1995;36(Abstract 74):194.
67. Fuks AB. Current concepts in vital primary pulp therapy. Eur J
Paediatr Dent. 2002;3:115–120.
68. Ricketts DNJ, Kidd EAM, Innes N, et al. Complete or ultraconserva-
tive removal of decayed tissue in unlled teeth. Cochrane Database
Syst Rev. 2006;(3):CD003808.
69. Al-Zayer MA, Straon LH, Feigal RJ, et al. Indirect pulp treatment
of primary posterior teeth: a retrospective study. Pediatr Dent.
2003;25:29–36.
70. Farooq NS, Coll JA, Kuwabara A. Success rates of formocresol
pulpotomy and indirect pulp therapy in the treatment of deep
dentinal caries in primary teeth. Pediatr Dent. 2000;22:278–286.
71. Marchi JJ, de Araujo FB, Froner AM, et al. Indirect pulp capping
in the primary dentition: a 4-year follow-up study. J Clin Pediatr
Dent. 2006;31:68–71.
72. Straon LH, Loos P. e indirect pulp cap: a review and commentary.
J Israel Dent Assoc. 2000;17:7.
73. Straon LH, Corpron RL, Bruner FW, et al. Twenty-four-month
clinical trial of visible-light activated cavity liner in young permanent
teeth. ASDC J Dent Child. 1991;58:124–128.
74. Coll JA, Seale NS, Vargas K, et al. Primary tooth vital pulp therapy: a
systematic review and meta-analysis. Pediatr Dent. 2017;39:217–225.
75. Hu CC, Zhang C, Qian Q, et al. Reparative dentin formation in
rat molars after direct pulp capping with growth factors. J Endod.
1998;24:744–751.
76. Rutheford RB, Wahle J, Tucker M, et al. Induction of reparative
dentine formation in monkeys by recombinant human osteogenic
protein-1. Arch Oral Biol. 1993;38:571–576.
77. Tziafas D, Alvanou A, Komnenou A, et al. Eects of recombinant
basic broblast growth factor, insulin-like growth factor-II and
transforming growth factor-beta 1 on dog dental pulp cells in vivo.
Arch Oral Biol. 1998;43:431–444.
78. Kennedy DB, Kapala JT. e dental pulp: biological considerations
of protection and treatment. In: Braham RL, Morris E, eds. Textbook
of Pediatric Dentistry. Baltimore: Williams & Wilkins; 1985.
79. Kashiwada T, Takagi M. New restoration and direct pulp capping
systems using adhesive composite resin. Bull Tokyo Med Dent Univ.
1991;38:45–52.
80. Araujo FB, Barata JS, Garcia-Godoy F. Clinical and radiographic
evaluation of the use of an adhesive system over primary dental
pulps. J Dent Res (special issue). 1996;75:280(Abstract 2101).
81. Kopel HM. e pulp capping procedure in primary teeth “revisited.
ASDC J Dent Child. 1997;64:327–333.
82. Araujo FB, Barata JS, Costa CAS, et al. Clinical, radiographical and
histological evaluation of direct pulp capping with a resin in primary
teeth. J Dent Res (special issue). 1997;76:179(Abstract 1327).
83. Pameijer CH, Stanley HR. e disastrous eects of the “total etch
technique in vital pulp capping in primates. Am J Dent. 1998;Spec
No:S45–S54.
84. Pameijer CH, Stanley HR. Pulp capping with “total etch” and other
experimental methods. J Dent Res. 1999;78:219(Abstract 911).
85. Costa CA, Hebling J, Hanks CT. Current status of pulp capping with
dentin adhesive systems: a review. Dent Mater. 2000;16:188–197.
35. Reeves R, Stainley HR. e relationship of bacteria penetration and
pulpal pathosis in carious teeth. Oral Surg Oral Med Oral Pathol.
1966;22:59–65.
36. Coll JA, Campbell A, Chalmers NI. Eects of glass ionomer
temporary restorations on pulpal diagnosis and treatment outcomes
in primary molars. Pediatr Dent. 2013;35:416–421.
37. Maltz M, Jardim JJ, Mestrinho HD, et al. Partial removal of carious
dentine: a multicenter randomized controlled trial and 18-month
follow-up results. Caries Res. 2013;47:103–109.
38. Bjørndal L. Indirect pulp therapy and stepwise excavation. Pediatr
Dent. 2010;30:225–229.
39. Innes NP, Frencken JE, Bjørndal L, et al. Managing carious
lesions: consensus recommendations on terminology. Adv Dent
Res. 2016;28:49–57.
40. Fuks A, Guelmann M, Kupietzky A. Current developments in pulp
therapy for primary teeth. Endod Topics. 2012;23:50–72.
41. Holan G. Long-term eect of dierent treatment modalities for
traumatized primary incisors presenting dark coronal discoloration
with no other signs of injury. Dent Traumatol. 2006;22:14–17.
42. Eidelman E, Ulmansky M. Histopathology of the pulp in primary
incisors with deep dentinal caries. Pediatr Dent. 1992;14:372–375.
43. Kassa A, Day P, High A, et al. Histological comparison of pulpal
inammation in primary teeth with occlusal or proximal caries. Int
J Paediatr Dent. 2009;19:26–33.
44. Fusyama T. e process and results of revolution in dental caries
treatment. Int Dent J. 1997;47(3):157–166.
45. ten Cate JM. Remineralization of caries lesions extending into
dentin. J Dent Res. 2001;80:1407–1411.
46. Yoshiyama M, Tay FR, Doi J, et al. Bonding of self-etch and total
etch adhesives to carious dentin. J Dent Res. 2002;81:556–560.
47. Schwendicke F, Frencken JE, Bjorndal L, et al. Managing carious
lesions: consensus recommendations on carious tissue removal. Adv
Dent Res. 2016;28:58–67.
48. Ricketts D, Lamont T, Innes NPT, et al. Operative caries man-
agement in adults and children. Cochrane Database Syst Rev.
2013;(3):CD003808.
49. Green D, Mackenzie L, Banerjee A. Minimally invasive long-term
management of direct restorations; the ‘5 Rs”. Dent Update.
2015;42:413–426.
50. Ogawa K, Yamashita Y, Ichijo T, et al. e ultrastructure and
hardness of the transparent human carious dentin. J Dent Res. 1983;
62:7–10.
51. Corralo D, Maltz M. Clinical and ultrastructural eects of dierent
liners/restorative materials on deep carious dentin: a randomized
clinical trial. Caries Res. 2013;47:243–250.
52. Maltz M, Garcia R, Jardim JJ, et al. Randomized trial of partial vs.
stepwise caries removal. J Dent Res. 2012;91:1026–1031.
53. Schwendicke F, Dörfer CE, Paris S. Incomplete caries removal: a
systematic review and meta-analysis. J Dent Res. 2013;92:306–314.
54. Stanley HR. Pulpal responses to ionomer cements—biological
characteristics. J Am Dent Assoc. 1990;120:25–29.
55. Brannstrom M. Communication between the oral cavity and
the dental pulp associated with restorative treatment. Oper Dent.
1984;9:57–68.
56. Hilton TJ. Keys to clinical success with pulp capping: a review of
the literature. Oper Dent. 2009;34:615–625.
57. Mahler DB, Engle JH, Simms LE, et al. One-year clinical evaluation
of bonded amalgam restorations. J Am Dent Assoc. 1996;127:345–349.
58. Falster CA, Araujo FB, Straon LH, et al. Indirect pulp treat-
ment: in vivo outcomes of an adhesive resin system vs calcium
hydroxide for protection of the dentin-pulp complex. Pediatr Dent.
2002;24:241–248.
59. Eidelman E, Finn SB, Koulourides T. Remineralization of
carious dentin treated with calcium hydroxide. J Dent Child.
1965;32:218–225.
60. Ericson D, Zimmerman M, Raber H, et al. Clinical evaluation of
ecacy and safety of a new method for chemo-mechanical removal
of caries. A multi-centre study. Caries Res. 1999;33:171–177.

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348 Part 3 The Primary Dentition Years: Three to Six Years61. Motta LJ, Bussadori SK, Campanelli AP, et al. Randomized controlled clinical trial of long-term chemo-mechanical caries removal using Papacarie gel. J Appl Oral Sci. 2014;22:307–313.62. Bjørndal L, Darnnavan T. A light microscopic study of odontoblastic and non-odontoblastic cells involved in tertiary dentinogenesis in well-dened cavitated carious lesions. Caries Res. 1999;33:50–60.63. Ferracane JL, Cooper PR, Smith AJ. Can Interaction of materials with the dentin-pulp complex contribute to dentin regeneration? Odontology. 2010;98:2–14.64. Kanca J III. Replacement of a fractured incisor fragment over pulpal exposure: a case-report. Quintessence Int. 1993;24:81–84.65. Casagrande L, Falster CA, Di Hipolito V, et al. Eect of adhesive restorations over incomplete dentin caries removal: 5-year follow-up study in primary teeth. J Dent Child (Chic). 2009;76:117–122.66. Nakajima M, Sano H, Burrow MF, et al. Bonding to caries aected dentin. J Dent Res (special issue). 1995;36(Abstract 74):194.67. Fuks AB. Current concepts in vital primary pulp therapy. Eur J Paediatr Dent. 2002;3:115–120.68. Ricketts DNJ, Kidd EAM, Innes N, et al. Complete or ultraconserva-tive removal of decayed tissue in unlled teeth. Cochrane Database Syst Rev. 2006;(3):CD003808.69. Al-Zayer MA, Straon LH, Feigal RJ, et al. Indirect pulp treatment of primary posterior teeth: a retrospective study. Pediatr Dent. 2003;25:29–36.70. Farooq NS, Coll JA, Kuwabara A. Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. Pediatr Dent. 2000;22:278–286.71. Marchi JJ, de Araujo FB, Froner AM, et al. Indirect pulp capping in the primary dentition: a 4-year follow-up study. J Clin Pediatr Dent. 2006;31:68–71.72. Straon LH, Loos P. e indirect pulp cap: a review and commentary. J Israel Dent Assoc. 2000;17:7.73. Straon LH, Corpron RL, Bruner FW, et al. Twenty-four-month clinical trial of visible-light activated cavity liner in young permanent teeth. ASDC J Dent Child. 1991;58:124–128.74. Coll JA, Seale NS, Vargas K, et al. Primary tooth vital pulp therapy: a systematic review and meta-analysis. Pediatr Dent. 2017;39:217–225.75. Hu CC, Zhang C, Qian Q, et al. Reparative dentin formation in rat molars after direct pulp capping with growth factors. J Endod. 1998;24:744–751.76. Rutheford RB, Wahle J, Tucker M, et al. Induction of reparative dentine formation in monkeys by recombinant human osteogenic protein-1. Arch Oral Biol. 1993;38:571–576.77. Tziafas D, Alvanou A, Komnenou A, et al. Eects of recombinant basic broblast growth factor, insulin-like growth factor-II and transforming growth factor-beta 1 on dog dental pulp cells in vivo. Arch Oral Biol. 1998;43:431–444.78. Kennedy DB, Kapala JT. e dental pulp: biological considerations of protection and treatment. In: Braham RL, Morris E, eds. Textbook of Pediatric Dentistry. Baltimore: Williams & Wilkins; 1985.79. Kashiwada T, Takagi M. New restoration and direct pulp capping systems using adhesive composite resin. Bull Tokyo Med Dent Univ. 1991;38:45–52.80. Araujo FB, Barata JS, Garcia-Godoy F. Clinical and radiographic evaluation of the use of an adhesive system over primary dental pulps. J Dent Res (special issue). 1996;75:280(Abstract 2101).81. Kopel HM. e pulp capping procedure in primary teeth “revisited. ASDC J Dent Child. 1997;64:327–333.82. Araujo FB, Barata JS, Costa CAS, et al. Clinical, radiographical and histological evaluation of direct pulp capping with a resin in primary teeth. J Dent Res (special issue). 1997;76:179(Abstract 1327).83. Pameijer CH, Stanley HR. e disastrous eects of the “total etch” technique in vital pulp capping in primates. Am J Dent. 1998;Spec No:S45–S54.84. Pameijer CH, Stanley HR. Pulp capping with “total etch” and other experimental methods. J Dent Res. 1999;78:219(Abstract 911).85. Costa CA, Hebling J, Hanks CT. Current status of pulp capping with dentin adhesive systems: a review. Dent Mater. 2000;16:188–197.35. Reeves R, Stainley HR. e relationship of bacteria penetration and pulpal pathosis in carious teeth. Oral Surg Oral Med Oral Pathol. 1966;22:59–65.36. Coll JA, Campbell A, Chalmers NI. Eects of glass ionomer temporary restorations on pulpal diagnosis and treatment outcomes in primary molars. Pediatr Dent. 2013;35:416–421.37. Maltz M, Jardim JJ, Mestrinho HD, et al. Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results. Caries Res. 2013;47:103–109.38. Bjørndal L. Indirect pulp therapy and stepwise excavation. Pediatr Dent. 2010;30:225–229.39. Innes NP, Frencken JE, Bjørndal L, et al. Managing carious lesions: consensus recommendations on terminology. Adv Dent Res. 2016;28:49–57.40. Fuks A, Guelmann M, Kupietzky A. Current developments in pulp therapy for primary teeth. Endod Topics. 2012;23:50–72.41. Holan G. Long-term eect of dierent treatment modalities for traumatized primary incisors presenting dark coronal discoloration with no other signs of injury. Dent Traumatol. 2006;22:14–17.42. Eidelman E, Ulmansky M. Histopathology of the pulp in primary incisors with deep dentinal caries. Pediatr Dent. 1992;14:372–375.43. Kassa A, Day P, High A, et al. Histological comparison of pulpal inammation in primary teeth with occlusal or proximal caries. Int J Paediatr Dent. 2009;19:26–33.44. Fusyama T. e process and results of revolution in dental caries treatment. Int Dent J. 1997;47(3):157–166.45. ten Cate JM. Remineralization of caries lesions extending into dentin. J Dent Res. 2001;80:1407–1411.46. Yoshiyama M, Tay FR, Doi J, et al. Bonding of self-etch and total etch adhesives to carious dentin. J Dent Res. 2002;81:556–560.47. Schwendicke F, Frencken JE, Bjorndal L, et al. Managing carious lesions: consensus recommendations on carious tissue removal. Adv Dent Res. 2016;28:58–67.48. Ricketts D, Lamont T, Innes NPT, et al. Operative caries man-agement in adults and children. Cochrane Database Syst Rev. 2013;(3):CD003808.49. Green D, Mackenzie L, Banerjee A. Minimally invasive long-term management of direct restorations; the ‘5 Rs”. Dent Update. 2015;42:413–426.50. Ogawa K, Yamashita Y, Ichijo T, et al. e ultrastructure and hardness of the transparent human carious dentin. J Dent Res. 1983; 62:7–10.51. Corralo D, Maltz M. Clinical and ultrastructural eects of dierent liners/restorative materials on deep carious dentin: a randomized clinical trial. Caries Res. 2013;47:243–250.52. Maltz M, Garcia R, Jardim JJ, et al. Randomized trial of partial vs. stepwise caries removal. J Dent Res. 2012;91:1026–1031.53. Schwendicke F, Dörfer CE, Paris S. Incomplete caries removal: a systematic review and meta-analysis. J Dent Res. 2013;92:306–314.54. Stanley HR. Pulpal responses to ionomer cements—biological characteristics. J Am Dent Assoc. 1990;120:25–29.55. Brannstrom M. Communication between the oral cavity and the dental pulp associated with restorative treatment. Oper Dent. 1984;9:57–68.56. Hilton TJ. Keys to clinical success with pulp capping: a review of the literature. Oper Dent. 2009;34:615–625.57. Mahler DB, Engle JH, Simms LE, et al. One-year clinical evaluation of bonded amalgam restorations. J Am Dent Assoc. 1996;127:345–349.58. Falster CA, Araujo FB, Straon LH, et al. Indirect pulp treat-ment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex. Pediatr Dent. 2002;24:241–248.59. Eidelman E, Finn SB, Koulourides T. Remineralization of carious dentin treated with calcium hydroxide. J Dent Child. 1965;32:218–225.60. Ericson D, Zimmerman M, Raber H, et al. Clinical evaluation of ecacy and safety of a new method for chemo-mechanical removal of caries. A multi-centre study. Caries Res. 1999;33:171–177. CHAPTER 23 Pulp Therapy for the Primary Dentition 349 107. 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Boj JR, Marco I, Cortes O, et al. e acute nephrotoxicity of systemically administered formaldehyde in rats. Eur J Paediatr Dent. 2003;4:16–20.105. Kahl J, Easton J, Johnson G, et al. Formocresol blood levels in children receiving dental treatment under general anesthesia. Pediatr Dent. 2008;30:393–399.106. Davis MJ, Myers R, Switkes MD. Glutaraldehyde: an alterna-tive to formocresol for vital pulp therapy. ASDC J Dent Child. 1982;49:176–180. 350 Part 3 The Primary Dentition Years: Three to Six Years151. Barr ES, Flatiz CM, Hicks MJ. A retrospective radiographic evaluation of primary molar pulpectomies. Pediatr Dent. 1991;13:4–9.152. Nurko C, Ranly DM, Garcia-Godoy F, et al. Resorption of a calcium hydroxide/iodoform paste (Vitapex) in root canal therapy for primary teeth: a case report. Pediatr Dent. 2000;22:517–520.153. Fuks AB, Eidelman E, Pauker N. Root llings with Endoas in primary teeth: a retrospective study. J Clin Pediatr Dent. 2002;27:41–45.154. Moskovitz M, Sammara E, Holan G. Success rate of root canal treatment in primary molars. J Dent. 2005;33:41–47.155. Primosch RE, Ahmadi A, Setzer B, et al. A retrospective assessment of zinc oxide-eugenol pulpectomies in vital maxillary primary incisors successfully restored with composite resin crowns. Pediatr Dent. 2005;27:470–477.156. Camp JH. Pulp therapy for primary and young permanent teeth. Dent Clin North Am. 1984;28:651–668.157. Holan G, Fuks AB. Root canal treatment with ZOE and KRI paste in primary molars: a retrospective study. Pediatr Dent. 1993;15: 403–407.158. Mani SA, Chawla HS, Tewari A, et al. Evaluation of calcium hydroxide and zinc oxide eugenol as root canal lling materials in primary teeth. ASDC J Dent Child. 2000;67:142–147.159. Mortazavi M, Mesbahi M. Comparison of zinc oxide and eugenol, and Vitapex for root canal treatment of necrotic primary teeth. Int J Paediatr Dent. 2004;14:417–424.160. Ozalp N, Saroğlu I, Sönmez H. Evaluation of various root canal lling materials in primary molar pulpectomies: an in vivo study. Am J Dent. 2005;18:347–350.161. Trairatvorakul C, Chunlasikaiwan S. Success of pulpectomy with zinc oxide-eugenol vs calcium hydroxide/iodoform paste in primary molars: a clinical study. Pediatr Dent. 2008;30:303–308.162. Mass E, Zilberman U. Endodontic treatment of infected primary teeth, using Maisto’s paste. ASDC J Dent Child. 1989;56: 117–120.163. Tagger E, Sarnat H. Root canal therapy of infected primary teeth. Acta Odontol Pediatr. 1984;5:63–66.164. Nurko C, Garcia-Godoy F. Evaluation of a calcium hydroxide/iodoform paste (Vitapex) in root canal therapy for primary teeth. J Clin Pediatr Dent. 1999;23:289–294.165. Kubota K, Golden BE, Penugonda B. Root canal lling materials for primary teeth: a review of the literature. ASDC J Dent Child. 1992;59:225–227.166. Takushige T, Cruz EV, Asgor Moral A, et al. Endodontic treatment of primary teeth using a combination of antibacterial drugs. Int Endod J. 2004;37:132–138.167. Prabhakar AR, Sridevi E, Raju OS, et al. Endodontic treatment of primary teeth using a combination of antibacterial drugs: an in vivo study. J Indian Soc Pedod Prev Dent. 2008;26(suppl 1):S5–S10.168. Iwaya S, Ikawa M, Kubota M. Revascularization of immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol. 2001;17:185–187.169. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004;30:196–200.170. Shah N, Logani A, Bhaskar U, et al. Ecacy of revascularization to induce apexication/apexogenesis in infected, nonvital, immature teeth: a pilot clinical study. J Endod. 2008;34:919–925.171. Goering AC, Camp JH. Root canal treatment in primary teeth: a review. Pediatr Dent. 1983;5(1):33–37.172. Klein U, Kleier DJ. Sodium hypochlorite accident in a pediatric patient. Pediatr Dent. 2013;35:534–538.173. Silva LA, Leonardo MR, Nelson-Filho P, et al. Comparison of rotary and manual instrumentation techniques on cleaning capacity and instrumentation time in deciduous molars. J Dent Child (Chic). 2004;71:45–47.174. Crespo S, Cortes O, Garcia C, et al. Comparison between rotary and manual instrumentation in primary teeth. J Clin Pediatr Dent. 2008;32:295–298.130. Eidelman E, Holan G, Fuks AB. Mineral trioxide aggregate vs. formocresol in pulpotomized primary molars: a preliminary report. Pediatr Dent. 2001;23:15–18.131. Sushynski JM, Zealand CM, Botero TM, et al. Comparison of gray mineral trioxide aggregate and diluted formocresol in pulpotomized primary molars: a 6- to 24-month observation. Pediatr Dent. 2012;34: 120–128.132. Noorollahian H. Comparison of mineral trioxide aggregate and formocresol as pulp medicaments for pulpotomies in primary molars. Br Dent J. 2008;204:E20.133. Fernandez CC, Martinez SS, Jimeno FG, et al. Clinical and radiographic outcomes of the use of four dressing materials in pulpotomized primary molars: a randomized clinical trial with 2-year follow-up. Int J Paediatr Dent. 2013;23:400–407.134. Erdem AP, Guven Y, Balli B, et al. Success rates of mineral trioxide aggregate, ferric sulfate, and formocresol pulpotomies: a 24-month study. Pediatr Dent. 2011;33:165–170.135. Moretti AB, Sakai VT, Oliveira TM, et al. e eectiveness of mineral trioxide aggregate, calcium hydroxide and formocresol for pulpotomies in primary teeth. Int Endod J. 2008;41:547–555.136. Sonmez D, Sari S, Cetinba T. A comparison of four pulpotomy techniques in primary molars: a long-term follow-up. J Endod. 2008;34:950–955.137. Subramaniam P, Konde S, Mathew S, et al. Mineral trioxide aggregate as pulp capping agent for primary teeth pulpotomy: 2 year follow up study. J Clin Pediatr Dent. 2009;33:311–314.138. Holan G, Eidelman E, Fuks A. Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol. Pediatr Dent. 2005;27:129–136.139. Farsi N, Alamoudi N, Balto K, et al. Success of mineral trioxide aggregate in pulpotomized primary molars. J Clin Pediatr Dent. 2005;29:307–311.140. Cardoso-Silva C, Barbería E, Maroto M, et al. Clinical study of mineral trioxide aggregate in primary molars. Comparison between grey and white MTA—a long term follow-up (84 months). J Dent. 2011;39:187–193.141. Smaïl-Faugeron V, Courson F, Durieux P, et al. Pulp treatment for extensive decay in primary teeth. Cochrane Database Syst Rev. 2014;(8):CD003220.142. Yildirim C, Basak F, Akgun OM, et al. Clinical and radiographic evaluation of the eectiveness of formocresol, mineral trioxide aggregate, portland cement, and enamel matrix derivative in primary teeth pulpotomies: a two year follow-up. J Clin Pediatr Dent. 2016;40:14–20.143. Rajasekharan S, Martens LC, Vandenbulcke J, et al. Ecacy of three dierent pulpotomy agents in primary molars: a randomized control trial. Int Endod J. 2017;50:215–228.144. Elliott RD, Roberts MW, Burkes J, et al. Evaluation of the carbon dioxide laser on vital human primary pulp tissue. Pediatr Dent. 1999;21:327–331.145. Gupta G, Rana V, Srivastava N, et al. Laser pulpotomy-an eective alternative to conventional techniques: a 12 months clinicoradio-graphic study. Int J Clin Pediatr Dent. 2015;8:18–21.146. Fernandes AP, Lourenço Neto N, Teixeira Marques NC, et al. Clinical and radiographic outcomes of the use of low-level laser therapy in vital pulp of primary teeth. Int J Paediatr Dent. 2015;25: 144–150.147. Marghalani AA, Omar S, Chen JW. Clinical and radiographic success of mineral trioxide aggregate compared with formocresol as a pulpotomy treatment in primary molars: a systematic review and meta-analysis. J Am Dent Assoc. 2014;145:714–721.148. Machida Y. Root canal therapy in deciduous teeth. Nihon Shika Ishikai Zasshi. 1983;36:796–802.149. Garcia-Godoy F. Evaluation of an iodoform paste in root canal therapy for infected primary teeth. ASDC J Dent Child. 1987;54:30–34.150. Flaitz CM, Barr ES, Hicks MJ. Radiographic evaluation of pulpal therapy for primary anterior teeth. ASDC J Dent Child. 1989;56:182–185. CHAPTER 23 Pulp Therapy for the Primary Dentition 351 175. Soares F, Varella CH, Pileggi R, et al. Impact of Er,Cr:YSGG laser therapy on the cleanliness of the root canal walls of primary teeth. J Endod. 2008;34:474–477.176. Canoglu H, Tekcicek MU, Cehreli ZC. Comparison of conventional, rotary, and ultrasonic preparation, dierent nal irrigation regimens, and 2 sealers in primary molar root canal therapy. Pediatr Dent. 2006;28:518–523.177. da Costa CC, Kunert GG, da Costa Filho LC, et al. Endodontics in primary molars using ultrasonic instrumentation. J Dent Child (Chic). 2008;75:20–23.178. Payne RG, Kenny DJ, Johnston DH, et al. Two-year outcome study of zinc oxide-eugenol root canal treatment for vital primary teeth. J Can Dent Assoc. 1993;59:528–530.179. Moskovitz M, Tickotsky N. Pulpectomy and root canal treatment (RCT) in primary teeth: techniques and materials. In: Fuks AB, Peretz B, eds. Pediatric Endodontics. Switzerland: Springer International Publishing; 2016. CHAPTER 23 Pulp Therapy for the Primary Dentition 351.e1 Case Study: Pulpotomy and Stainless Steel Crown ProceduresBrian D. HodgsonA 5-year-old male presents to the dental clinic with a chief complaint of cavities. The child is a recent immigrant to the United States, has public insurance, lives in a uoridated area, and has not seen a dentist before. A complete extraoral and intraoral exam is completed; however, patient is unable to tolerate a radiographic exam. Hygiene is poor, and there is gross caries throughout the dentition. The risks and benets of dental clinic treatment versus outpatient surgery treatment are reviewed with the parents. The parents elect restoration of the teeth with the child under general anesthesia.Upon the day of treatment, questioning of the parents in the preoperative area reveals that the patient has been recently complaining of a toothache when he eats sweets on the maxillary right posterior area. Upon further inquiry, the parents report that the symptoms go away almost immediately after the patient eats, and he has not complained of spontaneous or nocturnal pain. The treatment plan options are discussed with the parents, including stainless steel crown restorations, possible pulpal therapy, and possible extraction after a complete examination with radiographs is completed. After the patient is intubated, a full mouth series of radiographs are exposed. The periapical radiograph of the maxillary right quadrant is shown in Fig. E23.1. Clinically, there is no swelling or stulation, and the tooth is not mobile. As discussed in Chapter 23, remaining dentin thickness (ideally, at least 0.5 mm) is an important factor in mediating pulpal inammation. Fig. E23.1 shows caries encroaching on the pulpal tissue with little to no dentin thickness remaining.Tooth A is diagnosed as having reversible pulpitis. A rubber dam is placed, and caries is removed. Upon caries excavation, the pulp is exposed and pulpal therapy is initiated (Video 23.1). The remaining dentition is restored, and after recovering from general anesthesia, the child is discharged home. The parents schedule a follow-up appointment 2 weeks after the surgery. At that visit, all teeth, including tooth A, are asymptomatic and without signs of abscess. The dental clinic is established as the child’s dental home, and a prevention plan is instituted for the patient. The child is followed regularly, and years later tooth A is still in service (Fig. E23.2). Radiographic success is determined by intact periodontal ligament space without radiolucent areas in the furcation or at the apices with no signs of internal or external resorption (except for normal root resorption with the exfoliative process). Clinical success is determined by an asymptomatic tooth without stulation, swelling, mobility, or acute gingival inammation. The purpose of the pulpotomy procedure is to maintain the vitality of the radicular pulp so that the tooth may remain asymptomatic until normal exfoliation.Questions1. How do you differentiate between reversible pulpitis and irreversible pulpitis in a primary tooth?Answer: Because primary teeth do not respond to electric or cold pulp testing the same way that permanent teeth do, the diagnosis is made from clinical signs and symptoms. Signs and symptoms of reversible pulpitis include stimulated pain of short duration (<5 seconds) and pain that is adequately controlled by over-the-counter analgesics. Signs and symptoms of irreversible pulpitis include spontaneous pain that is not well controlled with over-the-counter analgesics or pain that wakes a child at night.2. Why is it important to place a rubber dam when anticipating a vital or nonvital pulp therapy procedure?Answer: Rubber dam placement helps to prevent or reduce: aspiration or swallowing of instruments used during the pulpal therapy procedures; chemical leakage of pulpotomy medicaments onto oral or pharyngeal tissues; contamination of the cleaned pulp chamber/root canals by bacteria from oral uids.3. How will healthy pulpal tissues appear when you remove the roof of the pulp chamber?Answer: Healthy pulp tissues will be pink in color and bleed when stimulated, and after removal of the coronal portion of the pulpal tissues, the hemorrhaging can be easily controlled with pressure.• Figure E23.1 Preoperative radiograph of tooth A. • Figure E23.2 Postoperative radiograph of tooth A approximately 5 years after initial treatment. 352 24 Behavior Guidance of the Pediatric Dental PatientJANICE A. TOWNSEND AND MARTHA H. WELLSCHAPTER OUTLINEUnderstanding the Child Patient: Review of Child DevelopmentCognitive DevelopmentLearning TheoryTemperamentCopingFactors Inuencing Child BehaviorDemographicsEnvironmentDental FearPainParental AnxietySetting the Stage for Successful Behavior GuidanceThe Dental OceSchedulingThe Dentist and the Dental TeamPatient AssessmentParents in the OperatorySetting Parent ExpectationsReview of Behavior Guidance TechniquesBasic Behavior GuidanceAlternative Communicative TechniquesAdvanced Behavior Guidance TechniquesMouth Props in Dentistry for ChildrenDocumenting Behavior and Use of Behavior Management TechniquesRole of Behavior Management in SocietyChanges in Society and ParentingChanging Parental Perspectives of Behavior ManagementThird-Party ReimbursementInformed ConsentPutting It All TogetherBehavior Guidance for the Infant/ToddlerBehavior Guidance for the PreschoolerBehavior Guidance for the School-Aged ChildBehavior Guidance for the AdolescentBehavior Guidance for the Child With Previous Negative Dental ExperiencesBehavior Guidance for the Child With Special Health Care NeedsConclusionpreferred term, behavior management will also be used in this chapter when referring to previously published works on the subject. e American Academy of Pediatric Dentistry (AAPD) denes behavior guidance as “the process by which practitioners help patients identify appropriate and inappropriate behavior, learn problem solving strategies, and develop impulse control and self-esteem.”1 e overall goal is the delivery of quality, safe dental care in an environment that is as pleasant as possible for children and which promotes a positive attitude toward oral health and future dental care. Dental treatment makes great demands on children, and they need the help of a caring practitioner to be able to cope with these demands. Dentists of every personality type can successfully treat children, and like all other aspects of dentistry, behavior guidance is a skill that requires practice, self-reection, and eort to improve.Pediatric dentistry is an age-dened specialty and is distin-guished by the art of behavior guidance. Whether introducing a toddler to dentistry or continuing to care for a middle-aged patient with intellectual disability, behavior guidance is essential to the delivery of quality dental care while building a trusting and positive relationship.Treating children can be one of the most rewarding experiences a dentist will encounter. With the proper mind-set, training, and environment, dentistry for children should be enjoyable for both the child and practitioner. e concept of behavior management has evolved over the years from the notion of “dealing with” the child to building a relationship with the child, parent, and dentist that is focused on meeting the child’s oral health care needs. Hence the terminology has also evolved from behavior management to behavior guidance. While behavior guidance is the CHAPTER 24 Behavior Guidance of the Pediatric Dental Patient 353 TemperamentIt is common to see widely varying behavior in families with shared environment and genetics, and this additional inuence is thought to be temperament. Temperament is used to describe traits that manifest early in life and are stable and consistent across dierent settings.6 Chess and omas classied children according to nine temperament categories and formulated three constellations of temperament made up of various combinations of the individual categories that had signicance: easy temperament, dicult tempera-ment, and slow-to-warm-up temperament, as described in Box 24.2.7Studies have shown that temperament, as measured by established psychological tools, can be signicantly associated with behavior at a dental visit. Aminabadi et al. found a correlation between Understanding the Child Patient: Review of Child DevelopmentTo understand behavior guidance is to understand the child and potential sources of poor cooperation and fear. Children are not little adults, and children of dierent ages have a unique understand-ing of the world around them. Communication must be adapted to meet their developmental needs. It is beyond the scope of this chapter to fully review all theories of child and personality develop-ment; however, a few concepts are necessary for a full discussion of behavior guidance.Cognitive Developmente term cognitive development describes the evolving ability of children to think, understand, and assign meaning to their experi-ences.2 Developmental theory is often presented in stages, which are periods of relatively stable behavior. e age that children reach a stage is variable, but the sequence is typically constant among healthy children. Jean Piaget’s stages of child development can help the clinician gain the perspective of the child patient, as summarized in Box 24.1, and are discussed further in the “Dynamics of Change” chapters (Chapters 13, 18, 30, and 37).Learning TheoryEarly learning theory asserts behavior is learned and the response to past behaviors inuences future behaviors.3 Fig. 24.1 illustrates how operant conditioning and reinforcement are relevant in pediatric dentistry. While this theory helps explain how some undesirable behavior can be extinguished, human behavior is more complex than the model of operant conditioning. Some children will not perform the desired behavior, even when both positive and negative stimuli are introduced. Moreover, this theory can also help explain how undesirable behavior can be inadvertently reinforced. For example, young children may perceive any adult attention as a type of positive reinforcement, and the parent and/or dentist may inadvertently reinforce inappropriate behaviors by verbally correcting the child.3,4 e American Academy of Pediatrics recommends active ignoring of minor infractions, and the dentist may consider ignoring minor movements or intentional misbehavior.5Data from Yates T. Theories of cognitive development. In: Lewis M, ed. Child and Adolescent Psychiatry: A Comprehensive Textbook. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 1996:134–155.Sensorimotor Stage (birth to 24 months)Infants use senses and motor abilities to understand the world and have little to no meaningful verbal communication other than single word commands. This is not to say that children are not aware of their surroundings; they are hyperaware of people around them as they reach this age and are perceptive to nonverbal communication.Preoperational Stage (2–5 years)Children begin to use language in similar ways to adults and can form mental symbols and words to represent objects. Language is concrete and literal and has limited logical reasoning skills. Children tend to perceive the world from their own perspective or be “egocentric.”Concrete Operational Stage (6–11 years)Children demonstrate increased logical reasoning skills and can see the world from different points of view. They still have a difcult time with abstract ideas and benet from concrete instructions.Formal Operations (11+ years)Children can think about abstractions and hypothetical concepts and reason analytically.Stages of Cognitive Development• BOX 24.1 OperantconditioningIncrease behavior Decrease behaviorPositive Negative PositiveNegative(presence of a stimulus)Ex: Specific praise forcooperation(presence of a stimulus)Ex: Voice control as a resultof poor cooperation(absence of a stimulus)Ex: Allowing a break/escapefrom treatment if child iscooperating(absence of a stimulus)Ex: Parent leaves operatorydue to poor cooperation• Figure 24.1 Operant conditioning and pediatric dentistry. Positive and negative reinforcement can be used to improve cooperation.

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