Volume 8, Issue 2, February – 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Pulpitis Treatment in Primary Teeth Via Biodentine,

Metapex and Zinc Oxide Eugenol
Khanukaev Nesia, Shevchenko Nina DMD, Shawdary Manar DMD

Abstract:- This study is a case study and non- periapical, furcation, and crown areas, as well as the status
experimental observational study based on individual of the adjacent bone in permanent teeth with closed apices.
case reports of pulpitis in primary teeth. The study I These factors are crucial for determining the correct
engaged in focusing on treatment via particular types of diagnosis and treatment prognosis.[11]
filling materials. Diagnosis was taken by patient history
anamnesis, clinical and paraclinical examination. In this Pulp interventions are a combination of a pulp
case study, the treatment was done in two types, treatment method and a medicament. The goal of these
pulpotomy and pulpectomy. Three types of material interventions is to preserve the health of the tooth and its
were used: Metapex, Zinc Oxide Eugenol and supporting tissues. Depending on the extent of the disease,
Biodentine. The patients came to assessment after 6 three pulp treatment methods are available: direct pulp
months and were evaluated for clinical and radiological capping, pulpotomy, and pulpectomy. In direct pulp
failure. capping, a therapeutic substance is placed directly on the
exposed pulp, pulpotomy, which involves removing a
 Aim portion of the pulp, pulpectomy, which entails removing all
Based on current research and clinical cases, the of the pulp in the pulp chamber and root canal of the tooth.
study aims to assess and investigate the depth, validity These treatments involve removing the caries and a portion
and advancement of pedodontics in the area of dental of the pulp tissue, followed by the application of
pulpitis in primary teeth. medicaments. This approach helps to maintain the
temporary integrity of the tooth. [2] Endodontic treatment is
Keywords:- Pulpitis, Primary Teeth, Irreversible Pulpitis, one method to save primary teeth until exfoliation when
Pulpotomy, Pulpectomy, Biodentine, Metapex, Zinc Oxide more advanced caries lesions reach the pulp-dentin complex
Eugenol. and cause pulp necrosis. [1] The ultimate objective of
endodontic treatment in pediatric dentistry is to preserve
I. INTRODUCTION primary teeth in the child's oral cavity while eliminating any
The most common chronic condition affecting children signs or symptoms.[6] The majority of non-vital pulp
that has a detrimental influence on their quality of life is treatment methods for primary teeth involve instrumenting
dental caries in primary teeth. [1] Primary teeth are and filing the root canals with resorbable materials. [1]
commonly impacted by extensive tooth decay, which is the The most often used materials are zinc oxide eugenol
most prevalent disease in this group of teeth. Approximately paste, calcium hydroxide, and iodoform paste. [1] The use
42% of children between the ages of 2 and 11 years old have of innovative and advanced materials to produce hard tissue
dental cavities in their primary teeth, averaging 1.6 decayed and preserve pulp vitality is becoming more and more
teeth per child. Sadly, most dental caries in children go popular. Progressive new materials have been created by
untreated. Furthermore, decay in primary teeth elevates the dental researchers in order to provide the best care for the
likelihood of decay in permanent teeth.[2] When caries patients. [7]
reach the pulp, it can result in symptoms such as
spontaneous pain, especially at night, pain upon biting, A. BIODENTINE
swelling within the mouth, or the formation of a sinus tract. Biodentine has high mechanical qualities, good sealing
[4] There are different classifications of pulpitis in primary ability with dentine, and biocompatibility similar to those of
teeth, including reversible and irreversible, acute and MTA, which can be used in direct contact with the pulpal
chronic. Inflammation can easily spread from the coronal to tissue. It met all the physiognomies of the ideal restorative
the radicular pulp, affecting the formation of the periodontal material, including having good physical and mechanical
apparatus and the tooth's growth zone. [3] qualities, technical aspects from the dentist's point of view,
patient acceptability, and other clinical features that
The type of pulp therapy depends on the diagnosis and contributed to the material's effectiveness.[8,9] In the
indications, which can be achieved through a combination of circumstance that the odontoblastic layer is only partially
clinical evaluation, dental and medical history, examination impaired, biodentine may accelerate pulp healing and
of oral and extra-oral signs, radiographic examination, and restoration. [10]
pulp sensitivity testing. Clinical diagnosis can determine
whether the pulpitis is reversible or irreversible and is based B. METAPEX
on factors such as pain intensity, location, duration, and Metapex (Metapex, Meta Dental, New York, USA) and
relief or aggravation. The correct diagnosis also takes into Vitapex (Neo Dental Chemical Products Co., Ltd., Tokyo,
account the sensibility of the pulp and surrounding Japan), which are a combination of calcium hydroxide and

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ISSN No:-2456-2165
iodoform, are another alternative for easy application in treatment via particular types of filling materials. Diagnosis
primary teeth pulpectomy. Studies have shown that this was taken by patient history anamnesis, clinical and
material has a favorable rate of resorption, reduced void paraclinical examination. In this case study, the treatment
formation, and satisfactory radiographic and clinical was done in two types, pulpotomy and pulpectomy. Three
outcomes. However, it has been observed that this types of material were used: Metapex, Zinc Oxide Eugenol
combination may not have a potent antimicrobial activity, and Biodentine. The patients came to assessment after 6
which may be due to the strong inhibitory effect of dentin. months and were evaluated for clinical and radiological
Another iodoform-based paste containing calcium failure. In this case study 17 kids between the ages of 3 and
hydroxide, Endoflas F.S.(Sanlor and Cia. S. en C.S., 6 years old were examined, diagnosed and treated with
Columbia, South America), has also been reported to have pulpitis at the Public Health Institution of Mother and Child
high clinical success rates.[5] Polyclinic and in a private dental pediatric clinic “Dr.
Romaniuc- clinica stomatologica", in Chisinau, Republic of
C. ZOE Moldova, supervised by Dr. Nina Shevchenko and Dr.
Zinc oxide eugenol (ZOE) paste has been the Manar Shawdary from November 2022 to January 2023.
traditional and widely accepted root canal filling material Out of 17 patients; 9 of them were males and 8 were females
for primary teeth since its introduction in 1930. Studies have (Table 1). All patients selected for this study were affected
reported moderate to high success rates with ZOE paste, by chronic (irreversible or necrosed) pulpitis, without any
with over 90% success reported. However, it has some pathological root resorption or periapical process on the
disadvantages such as the difference in rate of resorption radiographic picture. The children displayed symptoms such
compared to that of the root, risk of deflection of the as dull pain that lasted for about an hour, as well as times
erupting successor teeth especially in cases of overfill, and when there was no pain but the parents recognized the child
concerns about its antimicrobial activity which may become having a sharp, severe pain a few weeks prior. Not all of the
limited after the material is set.[4,5] patients responded to thermal tests. Due to poor oral hygiene
and lack of skills to deal with an uncooperative child by the
II. MATERIALS AND METHOD OF RESEARCH parents results in the patient's poor overall oral health. A
A. Method of the research dental plaque coating was seen on the majority of the
This study is a case study and non-experimental individuals, plaque and bacteria carried out to untreated
observational study based on individual case reports of caries that eventually led to pulpitis.
pulpitis in primary teeth. The study I engaged in focusing on

Material used Number of patients of the study

Biodentine 6 cases (35.3%)

2 male cases(33.3%), 4 female case (66.6%)

Metapex 5 cases (29.4%)

3 male cases(60%), 2 female cases (40%)

ZOE 6 cases (35.3%)

4 male cases(66.6%), 2 female cases (33.3%)
Table 1: Cases count per materials treated in pulpitis in primary teeth

Evaluation of efficiency of the material treatment of The search engine was done with PubMed, Google
pulpitis in primary dentition took place by the cooperation Scholar, Wiley Library and Cochrane Library for scientific
of the patients and their parents. The patients were examined article keywords: pulpitis in primary teeth, pulpectomy,
and diagnosed thoroughly by history anamnesis, clinical pulpotomy.
picture and paraclinical picture as panoramic x-ray, bitewing
x-ray or periapical x-ray with chronic irreversible pulpitis B. Patient examination and diagnosis
and without evidence of radiologic pathology of bone or In this study, all patients were welcomed to the dental
pathological root resorption . Subsequently, treatment is office and underwent data collection, medical history and
done with one of the three different materials that are used anamnesis to facilitate accurate diagnosis. The patient’s
in the study. Treatment for pulpotomy was done with parents participating in the study reported no history of
Biodentine, and treatment for pulpectomy was done with congenital or hereditary chronic conditions of the child. The
either Metapex or ZOE by randomization (Figure 1). X-ray patients and their parents were asked questions regarding the
pictures are taken before and after treatment. After 6 months infected tooth:
the patient returns, evaluation of the clinical and paraclinical  Is pain present? If yes, defines the pain, does it persist
examinations are taken and the presence of clinical failure when the stimulus is removed?
and radiological failure is checked.  What triggers the pain.
 How often, how bad and how long?
 Do you experience any fever or swelling?

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 Were medications used, if yes, which? mixing tray and spread on the lentula. Meanwhile, the ZOE
was blended in a 1:1 ratio of zinc oxide powder and eugenol
During the clinical examination, an exobuccal liquid, on the mixing tray and then placed on the lentula.
inspection and palpation was performed to assess any After filling the pulp cavity, restoration was applied. In
pathological features such as color asymmetry of the face cases of ZOE, Glass Ionomer Cement (GIC) was utilised
and presence of any enlarged, tender or mobile lymph due to eugenol's inhibiting effect on composite
nodes. No extraoral pathological signs were found in all polymerization. GIC Fuji IX by GC (Figure 25) was mixed
patients. An intraoral examination was conducted to inspect with a 1:1 ratio of liquid and powder and applied to the
for any abnormalities in color, lesions, or tooth cavities. dried cavity on top of the ZOE. For Biodentine and
Probing was done to evaluate tooth hardness and the depth Metapex, most cases utilised only the compomer. Etching
and softness of the cavity. The probe handle was used for applied with 37% phosphoric acid semi-gel for 10 seconds,
percussion to determine pain in the horizontal plane. Tooth then thoroughly rinsed and dried. The bonding material,
mobility was evaluated through palpation. Lastly, a thermal Prime&Bond by Dentsply Sirona, was applied and cured
test was performed using ethyl chloride gas applied on a with a light cure lamp. The compomer Dyract eXtra by
small cotton roll on the tooth crown to observe the reaction. Dentsply Sirona was then layered on and polymerized with
In acute pulpitis, there will be severe pain that takes longer the same light cure lamp. In some instances where the
to subside, while in chronic pulpitis the reaction will be mild patient was less cooperative, GIC was used to fill the cavity
or absent in the case of pulp necrosis. A normal reaction is a in the same manner as in ZOE. The occlusion was checked
brief sensation without pain. Paraclinical examination was via articulating paper blue 40miu, polished and corrected
taken to confirm the pulpitis diagnosis and to make sure with a high speed handpiece and olive and spear burs, final
there is no pathological periapical process or pathological polishing was completed with silicone polishers and contour
root resorption of the affected tooth. discs. At the six-month follow-up appointment, the patient
presented for evaluation of potential clinical or radiological
C. Materials used in the Research failure in the treated primary tooth. Clinical failure was
The treatment of the infected tooth was carried out determined by assessing the presence of pain or discomfort,
after a proper diagnosis was made. To minimise any swelling, and discoloration. Radiological failure was
potential discomfort or pain for the patient, topical and assessed through the use of radiographs, which were
injectable anaesthesia were administered. In all cases, examined for evidence of periapical radiolucency and
infiltrative anaesthesia was utilised. Benzocaine 20% gel widening of the periodontal ligament space, as well as
applied topically to the gingival area surrounding the tooth pathological root resorption.
in the future injection site. The injectable infiltrative
anaesthesia, consisting of articaine 4% with adrenaline III. CASES
1:100,000 by Septodont , was then administered via a 30G
diameter and 25mm length needle from the buccal, lingual, A. Case 1 - Pulpotomy with Biodentine
and interdental directions. The patient was given time for
the anaesthetic to take effect. Isolation of the prepared tooth  Patient present
was achieved through either rubber dam or cotton rolls,  Four year old and two months
based on the patient's level of cooperation. The affected  Female
tissue was then removed using low speed round bur and
excavator, and any smoothing of the walls was completed  Chief Complaint
with high speed spear or conical shape burs. Access to the  The mother reported that the child experienced severe
pulp chamber was gained after removal of all affected soft pain during the night, causing them to wake up 10 days
tissue, any remaining tissue was removed using low speed prior.
instruments. Anticoagulant solutions and materials, such as  Pain description
Astringedent (15.5% Ferric Sulfate) by Ultradent, were used  Three days of pain without any history of fever or
as necessary, and an anticoagulative sponge was employed swelling, no medication was used
if bleeding persisted. Irrigation was performed using  Pain is triggered while eating cold or sweat and lasts a
chlorhexidine 2% by TehnoDent with an Ultra max couple minutes.
Ultrasonic root canal cleaning device by Denco. In
pulpectomy cases, canal irrigation was also done with the  Social History
same solution and device. Rotatory canal NiTi kids files by  Youngest of three children
Decno were utilised exclusively for pulpectomy procedures.  Lower socioeconomic status
For pulpotomy, the pulp cavity was dried and filled with
Biodentine by Septodont. The Biodentine capsule was  Medical History
opened, 5 drops of the liquid were added, the capsule was  Review of the medical history showed no congenital or
closed and mixed in an amalgamator for 30 seconds 4200 hereditary conditions, no reported allergies to drugs or
RPM in a triturator to achieve a putty-like consistency. The foods, no current medication use, and that all
biodentine was then applied with an applicator in the pulp vaccinations were up to date.
chamber. In pulpectomy cases, the canal was dried with
absorbent paper points Wave one Gold by Dentsply and  Dental History
filled with either Metapex by Meta-Biomed or Zinc Oxide  Been to a dentist in the past
Eugenol with a lentula. The Metapex was distributed on a

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 Poor oral hygiene  Irrigation of the cavity - chlorhexidine 2% by
 A diet low in protein and high in carbohydrates TehnoDent with an Ultra max Ultrasonic root canal
 The use of toothpaste that contains fluoride cleaning device by Denco (Figure 1).
 Adequate water fluoridation levels  Pulp cavity filled with Biodentine by Septodont
 No reported history of dental injury.  Restoration - 37% phosphoric acid semi-gel etching for
10 seconds, rinsed and dried, bonding material was
 Extraoral Examination applied with an applicator, light cured and compomer
 No notable results was placed in diagonal layers and light cured in each
layer.
 Intraoral Examination  Correcting and polishing - the bite was evaluated using
 Soft tissue an articulator, and adjustments were made using olive
 No notable results and spear burs. The surfaces were then smoothed with a
 Dental and Hard tissue contour disc and a silicone conical polisher. (Figure
 Complete primary dentition 2)(Figure 3)
 Moderate plaque buildup was found.
 Several teeth displayed advanced cavities.

 Diagnosis Tools
 Two bitewing x-ray was taken
 Thermal test with ethyl chloride gas patient described
throbbing, shooting pain that lasted several minutes

 Differential Diagnosis
 Deep caries
 Acute reversible pulpitis

 Diagnosis Fig. 1: Pulpotomy

 Based on the patient's history of pain, clinical
examination, and radiographic results, is a deep cavity
with irreversible pulpitis on tooth 74
 Extensive cavities present in other primary teeth.

 Issues
 Multiple untreated cavities
 Elevated risk of tooth decay due to various causes such
as a diet rich in tooth-decaying substances, inadequate
oral hygiene with significant plaque buildup
 Young child with low cooperation, who requires
significant treatment for many teeth.
Fig. 2: Final result
 Treatment Plan
 Explanation to the child's mother about the significance
of preserving the first primary molar, particularly before
the eruption of the first permanent molar for maintaining
proper spacing.
 Thorough treatment of all other cavities.
 Aftercare that includes: Instructions for postoperative
care and oral hygiene at home. Prevention plan to avoid
future decay. Schedule for future dental check-ups

 Treatment
 Anaesthesia - topical and infiltrative (articaine 4% with Fig. 3: X-ray Final result
adrenaline 1:100,000)
 Isolation - cotton rolls  Evaluation After 6 Months
 Preparation - low speed round bur, excavator and high  The clinical examination revealed no signs of failure,
speed with conical bur. with the treated tooth being free of pain, discomfort,
 Anticoagulant - Astringedent (15.5% Ferric Sulfate) by swelling, or discoloration.
Ultradent  The radiographic results showed no signs of radiological
failure, with no observable periapical changes, including

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no radiolucency or alterations in the periodontal with irreversible pulpitis, and moderate tooth decay on
ligament space. tooth 85.
 Cavities present in other primary teeth.
B. Case 2 - Pulpectomy with Metapex

 Patient present
 Three year old and ten months
 Female

 Chief Complaint
 The mother reported that the child experienced pain last
week and currently constantly bothered by tooth on the
lower jaw Fig. 4: Clinical picture
 Pain description
 Pain to hot, cold or sweat and lasts for multiple minutes.

 Social History
 Only child
 Middle class

 Medical History
 An examination of the patient's medical history revealed
no evidence of congenital or hereditary disorders, no
reported sensitivities to drugs or food, no current
medication intake, and that all vaccinations were current Fig. 5: X-ray picture
and up-to-date.  Issues
 Multiple untreated dental cavities
 Dental History
 Risk of tooth decay is heightened due to various reasons,
 Previous dental visit including a diet high in tooth-decaying substances and
 Poor oral hygiene practices poor oral hygiene resulting in significant plaque
 Low protein, high carbohydrate diet accumulation.
 Use of fluoride-containing toothpaste
 Adequate water fluoridation  Treatment plan
 No history of dental injury reported  Explanation to the child's mother regarding the
importance of preserving the first primary molar,
 Extraoral Examination especially before the emergence of the first permanent
 No notable results molar, to ensure proper spacing.
 Comprehensive treatment for all other dental caries..
 Intraoral examination  Postoperative care plan that includes the following:
 Soft tissue home oral hygiene instructions, plan to prevent future
 No notable results decay and schedule for future dental appointments and
 Dental and Hard tissue check-ups.
 Complete primary dentition
 Moderate plaque buildup was found.  Treatment
 Several teeth displayed advanced cavities.  Anaesthesia - topical and infiltrative (articaine 4% with
adrenaline 1:100,000)
 Diagnosis Tools  Isolation - rubber dam, medium thickness with a clasp
 OPG x-ray was taken and safely wire
 Thermal test with ethyl chloride gas patient described  Preparation - low speed round bur, excavator and high
sharp pain that lasted several minutes speed with spear bur.
 Anticoagulant - 15.5% Ferric Sulfate and coagulating
 Differential diagnosis sponge
 Deep caries  Irrigation- chlorhexidine 2% by TehnoDent with an
 Acute reversible pulpitis Ultra max Ultrasonic root canal cleaning device by
Denco
 Diagnosis  Canal preparation - Rotatory canal NiTi kids files by
 The patient's history of pain, clinical examination Decno (Figure 6)
(Figure 4), and radiographic results (Figure 5) indicate  Canal filling - Canal dried with paper point and filler
the presence of a deep cavity near the root of tooth 84 with Metapex using a lentula.

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 Restoration - 37% phosphoric acid semi-gel etching for  Chief Complaint
10 seconds, rinsed and dried, bonding material was  The mother came with a child for yearly dental check up
applied with an applicator, light cured and compomer - child has no complain
was placed in diagonal layers and light cured in each
layer.  Social History
 Correcting and polishing - the bite was evaluated using  First child of two
an articulator, and adjustments were made using olive  Middle class
and spear burs. The surfaces were then smoothed with a
contour disc and a silicone conical polisher. (Figure 7)  Medical History
 X-ray - periapical x-ray was done to evaluate the results  A review of the patient's medical history uncovered no
(Figure 8) indications of congenital or hereditary conditions, no
reported sensitivities to drugs or food, no current
medications being taken, and all required vaccinations
were current and up-to-date.

 Dental History
 Previous dental appointment
 Inadequate oral hygiene practices
 Low protein, high carbohydrate diet
 Use of fluoride-containing toothpaste
 Adequate water fluoridation levels
 No history of dental trauma reported.
Fig. 6: Pulpectomy
 Extra oral Examination
 No notable results

 Intraoral Examination
 Soft tissue
 No notable results
 Dental and Hard tissue
 Complete primary dentition
 Sever plaque buildup was found.
 Several teeth displayed advanced cavities.
Fig. 7: Final result
 Diagnosis Tools
 OPG x-ray was taken
 Thermal test with ethyl chloride gas had signs for pain or
discomfort of the patient

 Differential Diagnosis
 Deep caries
 Acute reversible pulpitis

 Diagnosis
Fig. 8: X-ray Final result  The patient's pain history, clinical examination (Figure
9), and radiographic results (Figure 10) indicate the
 Evaluation after 6 months presence of a deep cavity near the root of tooth 84 with
 No signs of clinical failure were observed, as the irreversible pulpitis, and deep tooth decay on tooth 85.
affected tooth was free of pain, discomfort, swelling, and  Cavities present in other primary teeth.
discoloration.
 The radiographs revealed the absence of radiological
failure, with no periapical changes observed, such as
radiolucency or changes in the periodontal ligament
space.

C. Case 3 - Pulpectomy with Zinc Oxide Eugenol

 Patient Present
 Six year old and seven months
 Female
Fig. 9: Clinical picture of teeth 84

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Fig. 10: X-ray of teeth 84, 85 Fig. 11: Clinical Final result
 Issues
 Multiple unaddressed dental cavities
 Increased susceptibility to dental caries due to multiple
etiologies, including consumption of a diet containing
high amounts of substances detrimental to dental health,
and the presence of inadequate oral hygiene practices
resulting in substantial plaque accumulation.

 Treatment Plan
 Education provided to the parent of the child regarding Fig. 12: X-ray final result
the importance of conserving the first primary molar,
especially prior to the emergence of the first permanent  Evaluation After 6 Months
molar, in order to sustain appropriate spacing.  The absence of clinical failure was confirmed, with no
 Complete treatment of all other dental caries. symptoms of pain, discomfort, swelling, or discoloration
 Postoperative care instructions, oral hygiene measures to in the treated tooth.
be followed at home, and a plan for future decay  Radiographs indicated the absence of radiological
prevention were part of the aftercare regimen, along with failure, with no evidence of periapical changes,
a schedule for future dental examinations. including radiolucency or changes in the periodontal
ligament space.
 Treatment
 Anaesthesia - topical and infiltrative (articaine 4% with IV. OWN RESULTS AND DISCUSSIONS
adrenaline 1:100,000)
Results of the research In this study, evaluating the
 Isolation - cotton rolls
efficacy of various endodontic treatment materials (Table 2),
 Preparation - low speed round bur, excavator and high it was found that Biodentine was an effective material for
speed with spear bur. pulpotomy, as evidenced by the absence of clinical or
 Irrigation- chlorhexidine 2% by TehnoDent with an radiological failure in all six teeth at 6 months follow-up
Ultra max Ultrasonic root canal cleaning device by visits. Similarly, Metapex was found to be an effective
Denco material for pulpectomy, as there were no reports of clinical
 Canal preparation - Rotatory canal NiTi kids files by failure, or radiological failure in any of the five patients at 6
Decno months follow-up visits. Treatment with ZOE for
 Canal filling - Canal dried with paper point and filler pulpectomy also resulted in no pathological signs in the
with ZOE using a lentula. clinical evaluation of all teeth. However, one radiological
 Restoration - GIC is mixed and applied on the cavity . failure was observed among the six teeth treated with ZOE.
 Correcting and polishing - the bite was evaluated using
an articulator, and adjustments were made using olive Interpretation of data from literature A randomised
and spear burs. The surfaces were then smoothed with a control study review conducted by Cochrane Oral Health,
contour disc and a silicone conical polisher. (Figure 11) consisting of 87 trials that investigated pulp treatment
 X-ray - periapical x-ray was done to evaluate the results success in primary teeth, concluded that the comparison
(Figure 12) between Metapex and Zinc Oxide and Eugenol (ZOE) paste
was inconclusive, with no clear evidence of a difference
between the two treatments in terms of failure at 6 or 12
months, as determined by both clinical and radiological
evaluations (Smaïl-Faugeron et al. 2018).[2] However, my
trial indicated that ZOE indicated radiological failure, while
Metapex did not. The comprehensive review also found that
Biodentine treatment resulted in no statistically significant
clinical failure or pain at six and twelve months [2], which is
in line with the findings of my trial.

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A. Own Opinion conducted by Cochrane Oral Health concluded that the
Based on the results of my study and the information comparison between Metapex and ZOE was inconclusive,
gathered from the literature, it can be concluded that all with no clear evidence of a difference between the two
three materials, Biodentine, Metapex, and Zinc Oxide and treatments in terms of failure at 6 or 12 months. ZOE paste,
Eugenol (ZOE), are effective in pulpotomy and pulpectomy although effective in the clinical evaluation of all teeth in
treatments for primary teeth. Biodentine showed to be an my study, indicated one radiological failure among the six
effective material with no clinical or radiological failures in treated teeth. The review conducted by Cochrane Oral
all teeth at 6 months follow-up. This is supported by the Health also found the comparison between Metapex and
comprehensive review conducted by Cochrane Oral Health, ZOE to be inconclusive, with no clear evidence of a
which found no statistically significant clinical failure or difference between the two treatments in terms of failure.
pain in the use of Biodentine at 6 and 12 months. Metapex However, it is worth mentioning that ZOE is relatively
was also found to be effective in my study, with no reports cheaper compared to the other two materials.
of clinical or radiological failure in the patients. The review

Biodentine Metapex ZOE

Base (n = 17) n=6 n=5 n=6

6 months follow up (n = 17) n=6 n=5 n=6

Clinical finding

Success 6 (100%) 5 (100%) 6 (100%)

Failure 0 0 0

Radiographic finding

Success 6 (100%) 5 (100%) 5 (83.3%)

Failure 0 0 1 (16.67%)
Table 2: Clinical and Radiological success (S) and failure (F) rates for Biodentine pulpotomies , Metapex pulpectomy and ZOE
pulpectomy at 6 months of follow-up

V. CONCLUSION [4.] NajjarR. S. , AlamoudiN. M. , El‐Housseiny A. A. ,

Al Tuwirqi A. A. , and Sabbagh H. J. , “A
In conclusion, all three materials have their benefits comparison of calcium hydroxide/iodoform paste and
and limitations and the choice of material may depend on zinc oxide eugenol as root filling materials for
various factors such as cost, availability, and personal pulpectomy in primary teeth: A systematic review
preferences. As a dental practitioner, it is important to and meta‐analysis,” Clinical and Experimental Dental
consider the individual needs of each patient and make an Research, 2019, vol. 5, no. 3. pp. 294–310. doi:
informed decision based on the available evidence. 10.1002/cre2.173.
[5.] Ahmed H. M. A. , “Pulpectomy procedures in
REFERENCES primary molar teeth,” European Journal of General
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