179 - Analysis of Primary and Secondary Hemostasis in Primary Tooth Pulpotomies

Abstract:

Purpose: This retrospective study assessed whether patient-related factors predicted
the success of pressure-based (primary) hemostasis from a cotton pellet. The need
and efficacy of additional (secondary) chemical-induced hemostasis from 0.05%
Oxymetazoline (OXY) was also evaluated.

Methods: After IRB approval, 66 dental records of children aged 2 to 10 years with at
least one primary tooth requiring a pulpotomy were identified. For records with multiple
pulpotomy procedures, a single tooth was randomly selected per patient. Dental
records documented patient-related factors: gender, age, pre-operative symptoms,
number of caries surfaces, radiographic caries depth, and radiographic caries extension
below the CEJ. Logistic regression, using a backward stepwise approach, examined
how these factors were associated with the outcome of primary hemostasis after 60
seconds of application time. Additionally, dental records indicated the frequency and
efficacy of additional hemostasis with a 30-60-second application of OXY.

Results: Primary pressure-based hemostasis after 60 sec was accomplished in 56%
(37/66) of pulpotomy cases. Logistic regression did not identify patient-related factors
that predicted primary hemostasis. Full secondary hemostasis after 30-60 sec was
accomplished in 89.2% (25/28) of pulps treated with OXY. Three cases were deemed
to have partial hemostasis after 60 sec with OXY.

Conclusion: While the factors that predict primary pressure-based hemostasis were not
identified, this study determined that a nasal solution of 0.05% OXY applied directly to
the dental pulp induced rapid hemostasis prior to MTA pulp capping placement.
Additional clinical trials are needed to assess OXY potential role as a pulpal hemostatic
agent.

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