About this trial
The null hypothesis of the current study suggested that there will be no significant difference regarding the effect of Graphene Oxide (GO), Lesion sterilization and tissue repair (LSTR) and Zinc Oxide and Eugenol on the clinical and radiographic success rate of non-vital pulpotomy of primary teeth and that there will be no significant difference regarding the effect of Graphene Oxide (GO), MTA and Zinc Oxide and Eugenol on the clinical and radiographic success rate of vital pulpotomy of primary teeth.
The children (n=126) will be divided randomly into 2 arms; each arm has 3 groups, according to the type of pulp therapy dressing, medicament,t and technique of its application as follows:
First Arm (Vital Teeth) Group 1: will receive Graphene Oxide using the vital pulpotomy technique (study group, n=21) Group 2: will receive MTA using vital pulpotomy technique (study group, n=21) Group 3: will receive Zinc Oxide and Eugenol using the vital pulpotomy technique (control group, n=21) Second Arm (Non-Vital Teeth) Group A: will receive Graphene Oxide using the non-vital pulpotomy technique (study group, n=21).
Group B: will receive LSTR using the non-vital pulpotomy technique (study group, n=21).
Group C: will receive Zinc Oxide and Eugenol using non-vital pulpotomy (Control group, n=21).
Clinical and radiographic success will be assessed as primary outcomes, while pain, patient satisfaction,n and time of procedure will be assessed as secondary outcomes.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Cooperative child
Presence of symptom-free deep carious lesions
Presence of at least two-thirds of the root length radiographically; restorable tooth
Primary teeth diagnosed with pulp necrosis, root resorption equal to or less than one-third (with sufficient dental structure for absolute isolation with rubber dam)
Disqualifiers
History of systemic diseases
Teeth showing clinical and radiographical evidence of pulp degeneration, such as history of spontaneous or nocturnal pain, tenderness to percussion or palpation, pathologic mobility, swelling or fistulous tract, periodontal ligament (PDL) space widening, internal root resorption, external root resorption, furcal radiolucency/inter-radicular bone destruction, and/or periapical bone destruction
Teeth without a permanent successor
Teeth requiring more than 5 minutes to achieve hemostasis during the clinical procedure
Trial design
Parallel
Treatments tested in this trial
Graphene Oxide using vital pulpotomy technique
Other interventionAfter administering local anesthesia, the tooth will be isolated with a rubber dam. All caries will be removed, and coronal access will be gained using a sterile No. 330 bur mounted on a water-cooled high-speed turbine to expose the pulp chamber. A spoon excavator will be used for coronal pulp amputation. The pulp chamber will then be irrigated with saline solution to remove all debris. Hemostasis will be obtained with a moistened cotton pellet gently pressed against the amputated pulp stumps in both groups. Hemorrhage should stop within 5 min of applying the cotton pellet. Graphene Oxide will be applied to cover the pulp chamber. will be prepared as per the manufacturer's instructions to obtain a putty-like consistency. The mixture will be delivered to the pulp stumps and condensed lightly with a moistened sterile cotton pellet. A thick mix of the material will be applied Teeth of all tested groups will be restored after the pulp therapy using high-viscosity glass ionomer
MTA using vital pulpotomy technique
Other interventionAfter administering local anesthesia, the tooth will be isolated with a rubber dam. All caries will be removed, and coronal access will be gained using a sterile No. 330 bur mounted on a water-cooled high-speed turbine to expose the pulp chamber. A spoon excavator will be used for coronal pulp amputation. The pulp chamber will then be irrigated with saline solution to remove all debris. Hemostasis will be obtained with a moistened cotton pellet gently pressed against the amputated pulp stumps in both groups. Hemorrhage should stop within 5 min of applying the cotton pellet. MTA will be applied to cover the pulp chamber. will be prepared as per the manufacturer's instructions to obtain a putty-like consistency. The mixture will be delivered to the pulp stumps and condensed lightly with a moistened sterile cotton pellet. A thick mix of the material will be applied Teeth of all tested groups will be restored after the pulp therapy using high-viscosity glass ionomer
Zinc Oxide and Eugenol using vital pulpotomy technique
Other interventionAfter administering local anesthesia, the tooth will be isolated with a rubber dam. All caries will be removed, and coronal access will be gained using a sterile No. 330 bur will be mounted on a water-cooled high-speed turbine to expose the pulp chamber. A spoon excavator will be used for coronal pulp amputation. The chamber will then be irrigated with saline solution to remove all debris. Hemostasis will be obtained with a moistened cotton pellet gently pressed against the amputated pulp stumps in both groups. Hemorrhage should stop within 5 min of applying the cotton pellet. Zinc oxide Eugenol will be applied to cover the pulp chamber. will be prepared as per the manufacturer's instructions to obtain a putty-like consistency. The mixture will be delivered to the pulp stumps and condensed lightly with a moistened sterile cotton pellet. A thick mix of the material will be applied Teeth of all tested groups will be restored after the pulp therapy using high-viscosity glass ionomer
Graphene Oxide using non-vital pulpotomy technique
Other interventionAbsolute isolation with a rubber dam. Decayed dentin will be removed using spoon-shaped dentin excavators. The pulp chamber roof will be removed with a high-speed sterile carbide bur number 330, followed by irrigating the pulp chamber with two percent chlorhexidine solution and drying it with cotton balls. After these steps, a non-vital pulpotomy will be performed The coronal parts will be restored by preformed stainless steel crowns.
LSTR using non-vital pulpotomy technique
Other interventionAbsolute isolation with a rubber dam. Decayed dentin will be removed using spoon-shaped dentin excavators. The pulp chamber roof will be removed with a high-speed sterile carbide bur number 330, followed by irrigating the pulp chamber with two percent chlorhexidine solution and drying it with cotton balls. After these steps, a non-vital pulpotomy will be performed The coronal parts will be restored by preformed stainless steel crowns.
Zinc Oxide and Eugenol using non-vital pulpotomy
Other interventionAbsolute isolation with a rubber dam. Decayed dentin will be removed using spoon-shaped dentin excavators. The pulp chamber roof will be removed with a high-speed sterile carbide bur number 330, followed by irrigating the pulp chamber with two percent chlorhexidine solution and drying it with cotton balls. After these steps, a non-vital pulpotomy will be performed The coronal parts will be restored by preformed stainless steel crowns.
Treatment groups
6
Treatment groupsSee each treatment group below.
Trial outcomes
Primary outcomes
Clinical success
Assessing mobility, normal functioning, sensitivity to percussion, gingival inflammation, periodontal pocket formation, and presence or absence of sinus tract according to a scoring system from (1) to (4) as follows: Score (1): Asymptomatic Pathology: absent Normal functioning Mobility: (physiological) ≤ 1mm Score (2): Slight Discomfort, short-lived Pathology: questionable Percussion sensitivity Gingival inflammation: (due to poor oral hygiene) Mobility: (physiological) ≤ 1mm Score (3): Minor discomfort, short-lived Pathology: initial changes present Gingival swelling: (not due to poor oral hygiene) Mobility: \> 2 mm but \< 3 mm Score (4): Major discomfort, long-lived. Extract immediately Pathology: Late changes present Spontaneous pain Gingival swelling: (not due to poor oral hygiene) Periodontal pocket formation (exudate) Sinus tract present Mobility: ≤ 3mm Premature tooth loss due to pathology
Radiographic success
Radiographic evaluation will be assessed using a scoring system from score (1) to (4) as follows: Score (1): No changes at 6 months follow-up\* Internal root canal tapering from the chamber to the apex Periodontal ligament \\ periapical regions; normal width and trabeculation Score (2): Questionable Pathological changes at 3 months follow-up\* No External changes (widened PDL), abnormal inter-radicular trabeculation, or variation in radiodensity Internal resorption is acceptable (not perforated) Calcific metamorphosis is acceptable Score (3): Pathological changes present at 1-month follow-up\* External changes are present, but not large Mildly widened PDL Minor inter-radicular radiolucency with trabeculation still present Minor external root resorption; internal resorption changes are acceptable, but not if external changes are also present (perforated form) Score (4): Pathological changes are present. Extract immediately Frank osseous radiolucency present
Secondary outcomes
Presence or absence of pain
Each child will be asked to grade present pain on Wong-Baker faces pain rating scale (WBFPS). Providing an evaluation of pain intensity at the moment of interview of patient. These scales were present sequentially. Wong-Baker faces pain rating scale (WBFPS) presents 6 faces with increasing degree of pain from left to right. Each face was attributed scale from 0 to 10 indicated on scale. Children will be asked to choose the face that best describes his or her own pain. Children will taught that each face is for a child who has no pain or some, or a lot. Face 0 does not hurt at all, Face 2 hurts just a little bit, Face 4 hurts a little more, Face 6 hurts even more, Face 8 hurts a whole lot, and Face 10 hurts as much as you can imagine
Patient satisfaction
Will be assessed by 5-question Likert instrument assessment of satisfaction, patients will be asked to assess a number of statements in the five-point a novel Likert scale instrument, which includes five statements and five standard responses to them. Each of five statements was rated on a 5-point attitude scale of agreement-disagreement with treatment: Strongly disagree (1 score), Disagree (2 scores), Neither agree nor disagree (3 scores), Agree (4 scores), and Strongly-agree (5 scores).
Time of procedure
A calibrated stop watch will be used to record the time of the procedure. The recording time will start from the administration of anesthesia until the end of the procedure.
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