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The current study used a split-mouth design in order to compare more precisely the treatment modalities employed to and reduce specific variations that could influence the outcome. Each patient received both CP and VP in contralateral molars.
The results of the current study were in agreement with the results of Awad et al., 2013 (15) where calcium hydroxide and iodoform pulpotomy revealed 96% clinical success and 88% radiographic success after 12 months postoperatively. This might be due to utilization of the same material, pulp condition of molars comprising the inclusion criteria as well as adopting the concurrent technique of pulpotomy employed in pediatric dentistry clinics in Cairo University.
Further, success results in the current study were higher than those encountered by El-Meligy, 2011 (16) who showed that clinical and radiographic success rates were 90% and 70% respectively. This might be due to the use of ferric sulfate -hemostatic agent- ahead of placement of calcium hydroxide and iodoform premixed paste in the study performed by El-Meligy which might had acted as protein barrier underneath the paste.
The results of the current study were higher than the study performed by Alacam et al., 2009 (17) who showed that clinical and radiographic success rates were 17.2% and 13.8% after 12 months respectively. This difference might be encountered as in the study performed by Alacam, clinical procedures were carried out by fifth year undergraduate students, therefore different standards or different technique might had been performed.
In the current study, IR was categorized as a radiographic failure in accordance with El-Meligy, 2011(16) and Awad et al., 2013 (15). In spite of being categorized under radiographic failure, treated molars possessing IR were further examined during successive follow-up periods to detect any sign of clinical failure. This came in accordance to Eidelman et al., 2001(18) and Alacam et al., 2009 (17). Radiographic failures encountered in the current study were in the form of IR, ER and IRR. This was similar to radiographic failures shown by El-Meligy, 2011 (16), but in contrast to the results of Awad et al., 2013 (15), in which IR was not reported. This contradiction might have occurred as the result of presence or absence of pre-existing inflammation of radicular pulp prior to treatment commencement.
According to the results of the current study, molars treated by CP showed neither clinical nor radiographic signs of failure. In addition, no statistical significant difference was noted comparing results of molars treated by VP to CP clinically, whereas, significant difference was noted on radiographic examination. This came in agreement with a randomized controlled study by Roberts, 2009 (19) which compared indirect pulp treatment (IPT) to VP using formocresol and revealed that clinical success rates of IPT were higher than that of VP. Further, it was shown that after more than 12 months (in 26 pairs of primary molars), statistical significant pathologic radiographic changes were encountered more in VP versus IPT. Hereafter, this might indicate that CP or IPT might be acceptable alternatives to VP in primary molars with carious lesions in a period of 12 months postoperatively.