Health sciences bangalore, karnataka master of dental surgery

RAJIV GANDHI UNIVERSITY OF

HEALTH SCIENCES

BANGALORE, KARNATAKA

MASTER OF DENTAL SURGERY (M.D.S.)

DEPARTMENT OF PEDODONTICS AND

PREVENTIVE DENTISTRY
2011


AECS MAARUTI COLLEGE OF DENTAL SCIENCES AND RESEARCH CENTRE, BANGALORE.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE-II


SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.	NAME OF THE CANDIDATE AND ADDRESS	DR. ZEENATH AMBAREEN A.E.C.S. Maaruti College of Dental Sciences & Research Centre, Bangalore- 76
2	NAME OF THE INSTITUTION	A.E.C.S. Maaruti College of Dental Sciences & Research Centre #108, Hulimavu, Tank Bund Road, BTM 1^st Phase, Kammanahalli, Off Bannerghatta Road, Bangalore- 76
3	COURSE OF THE STUDY AND SUBJECT	MASTER OF DENTAL SURGERY(MDS) PEDODONTICS AND PREVENTIVE DENTISTRY
4	DATE OF ADMISSION TO THE COURSE	28^th May 2011
5	TITLE OF THE TOPIC	PROPOLIS: A NEW PULPOTOMY AGENT- AN IN VIVO STUDY

6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY: Pulpotomy is one of the most frequently used treatments for retaining cariously involved primary molars. Though various materials have been used in pulpotomy, formocresol is the most widely used. However, it has many disadvantages like cytotoxicity, pulpal inflammation and necrosis, systemic disturbances, mutagenic and carcinogenic potential and immunologic responses^1. Hence alternative materials have been proposed and used. One of the newer materials used in pulpotomies is Propolis^2. Propolis is a traditional medicine and known for its claimed beneficial effects on human health. Propolis has antioxidant, antibacterial, antifungal, antiviral anti-inflammatory, antitumor and immunomodulating properties^3. Propolis has been used in dentistry as an intracanal medicament, for wound healing, as an antiplaque agent, in the treatment of periodontitis, for storage of avulsed tooth, in the treatment of dentinal hypersensitivity and denture stomatitis, as a cariostatic agent and as a root canal irrigant^3. Recently propolis has also been used in pulp capping and pulpotomy^4. As there are not many studies in this regard, this study aims to compare propolis with formocresol as a pulpotomy agent.

6.2 REVIEW OF LITERATURE:

1. A study was done to compare the effectiveness of 10% propolis tincture and formocresol pulpotomy in primary molars of 50 children aged 4 to 10 years, on temporal molars with dead pulp (necropulpotomies). Two groups of 26 patients were formed; group A used 10% propolis tincture and group B was treated with formocresol.  The patients were evaluated on 7th , 15th and 30th  days. The results showed that 10% propolis tincture was effective due to high bactericidal power on the various toxins released by bacteria acting on pulp tissue breakdown².

2. A study compared the histological analysis of human pulp following direct pulp capping with propolis, mineral trioxide aggregate and dycal. 36 human premolars were mechanically exposed and divided into six groups of 6 teeth each. Group I and II were capped with propolis, group III and IV with mineral trioxide aggregate and group V and VI with Dycal. Final restoration was done with posterior composite resin using light cured glass ionomer cement as a liner. The teeth in group I, III and V were extracted after 15 days and group II, IV and VI were extracted on the 45^th day and processed for histological evaluation. Results showed that teeth capped with propolis and MTA exhibited lesser inflammation and more dentin bridge formation when compared to dycal which showed more inflammation and incomplete dentin bridge formation³.

3. A study histologically evaluated the repair of rat pulp tissue after pulpotomy and covering the pulp tissue with Copaifera langsdorffi oil resin, green propolis extract, fibrin sponge and iodoform-based paste. The study was done on maxillary and mandibular first molars of 21 wistar rats (84 teeth in total) divided randomly into 4 groups. After pulpotomy the pulp capping materials were applied and the access cavities were sealed with Coltosol and histological evaluations were performed. The results showed an inflammatory response constituted predominantly by neutrophils, being of milder intensity for the copaifera langsdorffi oil resin group and more severe for the fibrin sponge group which exhibited periapical microabscesses⁵.

4. A clinical, radiological and morphological evaluation of the effectiveness of a paste made from an alcoholic solution of propolis and zincoxide was done for the direct pulp capping of 50 teeth and indirect pulp capping of 150 teeth. The results showed that secondary dentin developed shortly after the application of the paste followed by the sclerous transformation of pulp in teeth with indirect pulp capping. A protective film developed at the opening of the pulp chamber followed by remineralization in teeth with direct pulp capping⁶.

5. A study compared the histological analysis of rat dental pulp to direct pulp capping with propolis on the right maxillary first molars of 27 Sprague Dawley rats divided into 3 groups of 9 rats each. The dental pulp was exposed and then capped with a zinc oxide-based filler as a control (group I), with propolis flavonoids (group II) and with non-flavonoids (group III). The rats were sacrificed at week 1, 2 or 4, biopsy samples were obtained. The results showed pulp inflammation and no dentin bridge formation in groups I and III. There was no evident pulp inflammation in group II. Direct  pulp capping  with  propolis in  rats may delay dental pulp inflammation and stimulate reparative dentin formation^7. 6.3 OBJECTIVES OF THE STUDY: 1. Clinical evaluation and comparison of formocresol and propolis pulpotomy on primary teeth at 3 and 6 months. 2. Radiographic evaluation and comparison of formocresol and propolis pulpotomy on primary teeth at 3 and 6 months.

7. MATERIALS AND METHODS:

7.1 SOURCE OF DATA The study will be conducted on forty primary teeth in healthy patients aged between 4-7 years visiting the Department of Pedodontics and Preventive Dentistry at A.E.C.S Maaruti College of Dental Sciences and Research Center, Bangalore.

INCLUSION CRITERIA 1. Healthy Co operative patient. 2. Carious exposure of vital pulp. 3. No clinical and radiographic evidence of pulp degeneration. 4. Radiographic evidence of presence of 2/3^rd of root. 5. Teeth which can be restored. 6. Children with prior parental consent. EXCLUSION CRITERIA 1. Continuous pain. 2. Presence of a swelling or a sinus tract in relation to tooth. 3. Exfoliating tooth. 4. Presence of interradicular bone loss. 5. Evidence of internal resorption. MATERIALS REQUIRED Mouth mirror & probe Pair of tweezers Rubber dam Radiographs Local anesthesia 2 ml disposable syringes Suction tips Gloves & mouth mask Aerotor handpiece No. 330 diamond bur Small and medium sized spoon excavators Formocresol 1:5 ratio (Pharmadent Remedies Pvt Ltd) Propolis 15% tincture (Nature’s Goodness Australia Pty Ltd) Cotton Mixing pad and spatula Zinc oxide eugenol cement Glass ionomer cement Stainless steel crowns (3M pretrimmed and precontoured) 7.2 METHODOLOGY: The forty teeth considered for the study will be radiographed preoperatively. The pulpotomy procedure will be performed on the 40 selected teeth which will be randomly divided into two groups according to the pulp dressing used. Group 1 will include 20 teeth which will be treated with formocresol and group 2 will be treated with propolis. The procedure is as follows: Following local anesthetic administration and rubber dam application the caries will be removed and coronal access will be obtained with a no. 330 high speed bur to expose the pulp chamber. A spoon excavator will be used for coronal pulp amputation, and a moistened cotton pellet will be used to achieve hemostasis. In group 1 a cotton pellet will be moistened with formocresol and after removing the excess it will be placed for 1 minute on the pulp stumps. In group 2 a cotton pellet will be moistened with 15% propolis tincture and after removing the excess it will be placed for 5 minutes on the pulp stumps. Reinforced zinc oxide eugenol dressing will be placed directly on the radicular pulp in both the groups. The patient will be recalled after 1 week to recieve stainless steel crowns. The patient is recalled after 3 and 6 months for clinical and radiographical evaluation. Two examiners blinded to the treatment will perform the evaluation. Clinical and radiographic evaluation will be performed at 3 and 6 months using following criteria^1. Clinical criteria: 1. No pain 2. No percussion sensitivity 3. No swelling and/or fistula 4. No pathologic tooth mobility Radiographic criteria: 1.No radiolucency in periapical or furcation area 2.No external or internal resorption 3.No widening of periodontal space The results will be tabulated and subjected to statistical analysis.

7.3 Does the study require any investigation or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

YES

7.4 Has the ethical clearance been obtained from your institution?

YES

8. LIST OF REFERENCES

1. Hadeer A, Agamy, Niveen S, Bakry, Maha M.F. Mounir, David R Avery. Comparison of Mineral Trioxide Aggregate and Formocresol as pulp capping agents in pulpotomized Primary Teeth. Pediatric Dentistry-26:4,2004

2. Valkyrie del Carmen, Gonzalez Rodriguez, Marcia Hortensia Corona Carpio, Mayra Raquel Martinez Ramos, Milanes Garcia Marylena and Leonardo Nunez. Pulpotomy in primary molar pulp with tincture of propolis 10%. Rev Cubana Estomatol V44 n.3 Cuidad de La Habana July-Sept 2007

3. Giovanna Pires da Silva Riberio, Lucaine Reberio. Invitro antimicrobial activity of endodontic pastes with propolis extracts and calciumhydroxide: a preliminary study. Brazilian Dental Journal(2008) 19(4):301-305

4. Abhishek Parolia, Manuel S Thomas, M Kundabala, Mandakini Mohan. Propolis and its potential uses in oral health. International Journal of Medicine and Medical sciences Vol. 2(7)pp. 210-215, July 2010

5. Raimunda Vilmar Evangelista Lima, Mabel Rodrigues Alves Esmeraldo, Mria Goretti Freire de Carvalho, Patricia Teixeira de Oliveira, Rejane Andrade de Carvalho, et al., Pulp repair after pulpotomy using different pulp capping agents: a comparative histologic analysis. Pediatric Dentistry Vol 33 no.1 Jan-Feb 2011

6. Ionita R, Sacalus A, Jivanescu M, Constantinescu I, Stanciu V, Bodnar C, Sacalus C. Experimentation of apiarian preparations for the direct and the indirect capping of the dental pulp. Stomatologie. 1990 Jan-Feb;37(1):19-30

7. Ardo Sabir, Charles R Tabbu, Purwanto Agustiono and Wihaskoro Sosroseno. Histologis analysis of rat dental pulp tissue capped with propolis. Journal of oral Science, Vol. 47, No.3, 135-138,2005

9.SIGNATURE OF THE CANDIDATE
10. REMARKS OF THE GUIDE	THIS STUDY IS SUITABLE FOR DISSERTATION
11. NAME AND DESIGNATION OF (IN BLOCK LETTERS)
11.1 GUIDE: 11.2 SIGNATURE:	DR.SAPNA KONDE M.D.S PROFESSOR AND HEAD, DEPARTMENT OF PEDODONTICS AND PREVENTIVE DENTISTRY A.E.C.S. MAARUTI COLLEGE OF DENTAL SCIENCES & RESEARCH CENTRE, BANGALORE
11.3 CO-GUIDE IF ANY: 11.4 SIGNATURE:	DR.SUNIL RAJ N. M.D.S PROFESSOR
11.5 HEAD OF THE DEPARTMENT 11.6 SIGNATURE 12. REMARKS OF THE CHAIRMAN AND PRINCIPAL 12.1 SIGNATURE OF THE CHAIRMAN AND PRINCIPAL	DR. SAPNA KONDE, M.D.S., PROFESSOR AND HEAD, DEPARTMENT OF PEDODONTICS & PREVENTIVE DENTISTRY A.E.C.S. MAARUTI COLLEGE OF DENTAL SCIENCES & RESEARCH CENTRE.