Pulpotomy in primary teeth has evolved significantly, transitioning from traditional medicaments like formocresol (FC) to biocompatible materials such as mineral trioxide aggregate (MTA), Biodentine, and ferric sulfate.
📌 Recommended Article :
Dental Article 🔽 Why Formocresol Is No Longer Recommended in Pediatric Pulp Therapy: Evidence-Based Risks and Modern Alternatives ... Current evidence raises serious concerns regarding systemic toxicity, mutagenicity, and potential carcinogenic effects, prompting professional organizations to reconsider its use.This article critically evaluates safety concerns, clinical outcomes, and current evidence-based recommendations, highlighting why modern agents are increasingly preferred in pediatric dentistry.
Advertisement
✅ Introduction
For decades, formocresol pulpotomy was considered the gold standard due to its ease of use and high clinical success rates. However, concerns regarding toxicity, systemic distribution, and potential carcinogenicity have prompted a shift toward bioactive and regenerative materials.
Today, clinicians must balance clinical success, biological compatibility, and long-term safety when selecting pulpotomy agents.
📌 Recommended Article :
Dental Article 🔽 Zinc Oxide Eugenol vs Calcium Hydroxide–Iodoform in Pulpectomy ... This review analyzes clinical performance, resorption behavior, success rates, and limitations, based on current evidence.✅ Current Pulpotomy Agents: An Overview
1. Formocresol (FC)
▪️ Fixative agent causing partial devitalization of pulp tissue
▪️ Antibacterial effect
▪️ Historically high success rates
▪️ Concerns: cytotoxicity and systemic exposure to formaldehyde
2. Mineral Trioxide Aggregate (MTA)
▪️ Bioactive material promoting dentin bridge formation
▪️ Excellent sealing ability
▪️ High biocompatibility
3. Biodentine
▪️ Calcium silicate-based material
▪️ Faster setting than MTA
▪️ Stimulates pulp regeneration
4. Ferric Sulfate
▪️ Hemostatic agent
▪️ Comparable outcomes to FC in some studies
📌 Recommended Article :
Dental Article 🔽 Pulpotomy vs. Pulpectomy in Primary Teeth: A Contemporary Clinical Guide ... Understanding the clinical indications, long-term outcomes, advantages, and limitations of each technique is essential for optimizing patient care and maintaining primary teeth until exfoliation.✅ Clinical Outcomes: Evidence-Based Comparison
Success Rates
▪️ Multiple systematic reviews demonstrate that MTA shows superior clinical and radiographic success compared to formocresol
▪️ Long-term data indicate:
- MTA success ≈ 95%
- Formocresol success ≈ 80%
▪️ Meta-analyses confirm statistically significant better outcomes with MTA in primary molars
Radiographic Findings
▪️ FC associated with:
- Internal root resorption
- Pulp canal obliteration
▪️ MTA shows:
- More favorable healing patterns
- Less pathological resorption
Newer Materials
▪️ Recent randomized trials (2024) show NeoMTA and calcium silicate materials outperform FC in both clinical and radiographic success
📌 Recommended Article :
PDF 🔽 What is the best pulp dressing for pulpotomies in primary teeth? - Review ... Different pulp dressings have been used in pulpotomies, each with different characteristics and properties. The article we share compares all pulp dressings to determine which is the most effective.✅ Safety Profile: A Critical Issue
Formocresol
▪️ Contains formaldehyde, classified as a potential carcinogen
▪️ Demonstrates:
- Cytotoxicity to pulp and periapical tissues
- Systemic distribution after application
▪️ Safety concerns remain controversial but significant in modern practice
Modern Agents (MTA, Biodentine)
▪️ Highly biocompatible
▪️ Promote tissue regeneration rather than fixation
▪️ Minimal systemic risk
📌 Recommended Article :
Dental Article 🔽 Mineral Trioxide Aggregate (MTA) in Pediatric Dentistry: Uses, Benefits, and Clinical Evidence ... Among them, Mineral Trioxide Aggregate (MTA) has emerged as a gold standard for pulp therapy, especially for its regenerative properties and sealing capability.💬 Discussion
The shift from formocresol to bioactive materials reflects a broader movement toward minimally invasive and biologically driven dentistry.
While FC still demonstrates acceptable short-term outcomes, its mechanism (tissue fixation and devitalization) contradicts current principles of vital pulp therapy, which emphasize preservation and regeneration.
Modern materials such as MTA and Biodentine not only achieve higher success rates but also align with biological healing processes, making them superior choices.
However, barriers remain:
▪️ Higher cost (especially MTA)
▪️ Technique sensitivity
▪️ Availability in low-resource settings
✍️ Conclusion
Formocresol is no longer the ideal pulpotomy agent in contemporary dentistry. Although it provides acceptable clinical outcomes, modern materials outperform it in both safety and long-term success.
MTA and other calcium silicate materials are currently the gold standard due to their:
▪️ Superior biocompatibility
▪️ Higher success rates
▪️ Regenerative potential
🎯 Clinical Recommendations
▪️ Prefer MTA or Biodentine for pulpotomy in primary teeth
▪️ Avoid routine use of formocresol, especially in pediatric patients
▪️ Consider ferric sulfate as an alternative where cost is a concern
▪️ Follow evidence-based guidelines (AAPD) for vital pulp therapy
▪️ Ensure proper case selection and coronal seal
📚 References
✔ Marghalani, A. A., Omar, S., & Chen, J. W. (2014). Clinical and radiographic success of mineral trioxide aggregate compared with formocresol as a pulpotomy treatment in primary molars: A systematic review and meta-analysis. Journal of the American Dental Association, 145(7), 714–721. https://doi.org/10.14219/jada.2014.36
✔ Ghajari, M. F., Mirkarimi, M., Vatanpour, M., & Kharrazi Fard, M. J. (2008). Comparison of pulpotomy with formocresol and MTA in primary molars: A systematic review and meta-analysis. Iranian Endodontic Journal, 3(3), 45–49.
✔ Wang, Y., Luo, S., Tang, W., Yang, L., Liao, Y., & Liu, F. (2022). Efficacy and safety of mineral trioxide aggregate pulpotomy for caries-exposed permanent teeth in children: A systematic review and meta-analysis. Translational Pediatrics, 11(4), 537–546. https://doi.org/10.21037/tp-22-68
✔ Gisour, E. F., Jahanimoghadam, F., & Karimipour, P. (2024). Clinical and radiographic comparison of primary molar pulpotomy using formocresol, Portland cement, and NeoMTA plus: A randomized controlled clinical trial. Scientific Reports, 14, 29690. https://doi.org/10.1038/s41598-024-81180-w
✔ Holan, G., & Fuks, A. B. (2013). A comparison of pulpotomy using formocresol and ferric sulfate. Pediatric Dentistry. (Referenced in systematic reviews)
📌 More Recommended Items
► Pulpotomy Failure in Primary Teeth: Causes, Early Warning Signs, and Evidence-Based Prevention
► Pulpotec® in Pulpotomy: Composition, Indications, Protocol & Clinical Pros and Cons
► Medications Used in Pulpotomies: Properties, Drawbacks, and Brand Names