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Review Article Efficacy of Vitapex on Chronic Periapical Periodontitis of Deciduous Teeth in Children and Risk Factors Affecting the Efficacy

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Review Article Efficacy of Vitapex on Chronic Periapical Periodontitis of Deciduous Teeth in Children and Risk Factors Affecting the Efficacy Int J Clin Exp Med 2020;13(7):5250-5258 www.ijcem.com /ISSN:1940-5901/IJCEM0111239 Review Article Efficacy of vitapex on chronic periapical periodontitis of deciduous teeth in children and risk factors affecting the efficacy Hongfeng Shen1, Yun Zhou2, Xiangzhao Sun1, Pan He1, Hongru Wu1 1Department of Stomatology, Jinzhou 968 Hospital, Jinzhou 121001, Liaoning Province, China; 2Department of Stomatology, Changchun 964 Hospital, Changchun 130021, Jilin Province, China Received March 23, 2020; Accepted April 23, 2020; Epub July 15, 2020; Published July 30, 2020 Abstract: To explore the efficacy of Vitapex on chronic periapical periodontitis of deciduous teeth in children and the risk factors affecting the efficacy. A total 188 children with chronic periapical periodontitis of their deciduous teeth were admitted to our hospital and enrolled, of which 82 patients were treated with zinc oxide-eugenol paste as a control group, and the rest were treated with Vitapex paste as an intervention group. The clinical indexes (time for restoration of dental function and treatment time), efficacy, and adverse reactions during treatment of the two groups were evaluated. The verbal rating scale (VRS) was employed to evaluate the pain degree of the children, enzyme-linked immuno-sorbent assay (ELISA) was used to determine the levels of serum inflammatory factors in the children, including interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α), and logistic regression was used to analyze risk factors affecting treatment efficacy in the children. After treatment, the inter- vention group experienced shorter time for restoration of normal dental function and shorter treatment time than the control group, as well as showing a higher total effective rate than the control group. In addition, after treatment, the incidence rate of adverse reactions of the intervention group was significantly lower than that of the control group, and the VRS score of the intervention group was lower than that of the control group. The levels of inflam- matory factors (IL-6, IL-1β and TNF-α) in the intervention group were also lower than those in the control group. The multivariate logistic regression analysis revealed that tooth brushing, premature delivery, treatment methods, time for restoration of dental function, treatment time, VRS score, and IL-6, IL-1β, and TNF-α were all risk factors affecting treatment efficacy in the children. Vitapex is effective in alleviating pain degree, shortening the time for restoration of normal dental function, and lowering the levels of inflammatory factors in the treatment of chronic periapical periodontitis of deciduous teeth. Keywords: Vitapex paste, zinc oxide-eugenol paste, chronic periapical periodontitis of deciduous teeth, efficacy, risk factors Introduction study proposed early diagnosis and treatment for it [9]. However, clinical treatment of chronic Periodontal disease is a complex disease with periapical periodontitis is complex due to a dif- many properties [1]. It is reported that children ficulty of instrument application and complex and adolescents may suffer from various kinds root tips. of periodontitis [2]. Mainly caused by bacterial infection, periodontitis can lead to inflammato- Dental pulp of deciduous teeth is usually treat- ry responses, and even loss of teeth [3-7]. Ch- ed by root canal and filling with iodoform pas- ronic periapical periodontitis is one of the main te, calcium hydroxide, and zinc oxide-eugenol. causes of premature loss of deciduous teeth, However, one clinical study has pointed out and it is related to infection of dental pulp in that zinc oxide-eugenol has slow tooth absorp- children [8]. One study has concluded that tion and simulates root tip tissues, resulting bone loss is likely to occur around the primary in cementum and bone necrosis [10]. Vitapex molars in children between 5 and 8 years old, paste can diffuse out or be absorbed by peri- causing aggressive periodontitis accompanied odontal macrophages of children within 1 to 2 by premature loss of deciduous teeth, and the weeks after being filled in at the tooth root and Treatment of chronic periapical periodontitis of deciduous teeth in children around the cusp, and it is weakly antibacterial did not have any subjective symptoms after [11]. Some studies have concluded that vita- treatment, and he/she showed no recurrence pex paste is an ideal material for root canal fill- of symptoms and experienced good chewing ings that can be absorbed extremely quickly in function recovery during six month follow-up. clinical practice [12]. For example, a study by Treatment of a child with the following out- Tang Y et al. [13] has shown that vitapex paste comes was determined as effective: The child is effective for root canal fillings in treating did not have any subjective symptoms after chronic periapical periodontitis, and contrib- treatment, and he/she showed no recurrence utes to low recurrence of the periodontitis. of symptoms and experienced good chewing function recovery during a six month follow-up, At present, there are few studies on the efficacy but he/she felt a slight pain in percussion. of vitapex paste and zinc oxide-eugenol paste Treatment of a child with the following out- on chronic periapical periodontitis of decidu- comes was determined as ineffective: The child ous teeth and the related influencing factors, had subjective symptoms after treatment, and so we decided to compare the efficacy of each he/she showed recurrence of symptoms in the of them on chronic periapical periodontitis of affected teeth during a six month follow-up. deciduous teeth, which is of great significance Moreover, he/she felt a strong pain in percus- for the selection of treatment strategies for sion. The total effective rate = (The number of children with this disease. patients with curative efficacy + the number of patients with effective efficacy)/the total num- Materials and methods ber of patients × 100%. General materials Treatment methods A total of 188 children with chronic periapical Before treatment, the overall situation of the periodontitis of deciduous teeth were admit- periodontal tissues in the children in the both ted to Jinzhou 968 Hospital and enrolled; of groups was evaluated and analyzed using X which 82 patients were treated with zinc oxide- ray to understand the periodontal lesions in eugenol paste as a control group, and the rest the children, and correspondingly root canal were treated with vitapex paste as an interven- fillings was carried outm. Opening of the pulp tion group. The control group consisted of 45 chamber was required in the children under males and 37 females, aged between 2 and 6 anesthesia, in order to uncover the root of the years old, with an average age of (5.43±1.41) pulp chamber to remove necrotic pulp and his- years. The intervention group consisted of 51 tocytes, and the sinus passage was flushed males and 55 females, aged between 2 and 7 with normal saline. Afterwards, the root canal years old, with an average age of (5.04±1.40) was repeatedly rinsed and disinfected with 3% years. This study was approved by the Ethics hydrogen peroxide and 0.9% sodium chloride. Committee of Jinzhou 968 Hospital, and all After the water was sucked out and dried with participants and their family members signed cotton balls, any children with pus exudation informed consent forms after understanding were given open drainage in the root canal for the study. The inclusion criteria of the child- 1-2 days, and then the open site was sealed ren were as follows: Children diagnosed with with zinc oxide temporarily according to the sit- chronic periapical periodontitis of their decidu- uation of each child. Preparations were made ous teeth [14], children who had not recei- for root canal fillings according to the situation ved pulp therapy and had not taken antibiotics of the children in the return visit. Children in within 2 weeks, and children with complete the intervention group were given root canal clinical data. The exclusion criteria were as fol- fillings with vitapex paste at a filling dosage lows: Children who dropped out from the ex- determined according to the condition of the children as follows: The tip of an injection periment, or who had taken drugs that may af- syringe with vitapex paste (Morita & Company, fect indexes of this study, children with other Japan, YYJ-075-VITAPEX2) was inserted gently comorbid oral diseases or infectious diseases, to 4/5 of the root canal. Subsequently, the and children lost to follow up. vitapex paste was gently injected to the root Efficacy assessment canal, and then the syringe was slowly lifted to fill the inside of the root canal with paste. Treatment of a child with the following out- Afterwards, gutta-percha points were added comes was determined as curative: The child in the root canal after the excess paste was 5251 Int J Clin Exp Med 2020;13(7):5250-5258 Treatment of chronic periapical periodontitis of deciduous teeth in children Table 1. Comparison between the two groups in general data [n (%), Outcome measures mean ± SD] The adverse reactions The control The intervention Factor n χ2/t P-value after treatment, time group (n=82) group (n=106) for restoration of nor- Sex 0.847 0.358 mal dental function, Male 96 45 (54.88) 51 (48.11) and treatment time in Female 92 37 (45.12) 55 (51.89) the two groups were Average age (Y) 188 5.43±1.41 5.04±1.40 1.888 0.061 recorded. Course of disease (Month) 188 7.01±0.31 7.07±0.33 1.269 0.206 The pain degree of the Disease site 1.901 0.168 children during treat- Primary molar 118 56 (68.29) 62 (58.49) ment was evaluated us- Deciduous front teeth 70 26 (31.71) 44 (41.51) ing the verbal rating Halitosis 0.007 0.940 scale (VRS) with a total No 98 43 (52.44) 55 (51.89) of 10 points.
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