Journal of Pharmacy And Bioallied Sciences
Journal of Pharmacy And Bioallied Sciences Login  | Users Online: 1883  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size 
    Home | About us | Editorial board | Search | Ahead of print | Current Issue | Past Issues | Instructions | Online submission




 
 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 57-61  

An update on newer pulpotomy agents in primary teeth: A literature review


1 Department of Paedodontics and Preventive Dentistry, Post Graduate Institute of Dental Sciences, Rothak, Haryana, India
2 Department of Orthodontics and Dentofacial Orthopedics, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India

Date of Submission03-Dec-2020
Date of Decision28-Dec-2020
Date of Acceptance29-Dec-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Bhagabati Prasad Dash
Department of Orthodontics and Dentofacial Orthopedics, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Patia, Bhubaneswar, Odisha
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_799_20

Rights and Permissions
   Abstract 


Primary molars with asymptomatic reversible pulpitis are commonly treated by pulpotomy procedure. Different pulpotomy materials used so far for pulpotomy that have been mentioned in the literature have been included in this article. This literature review includes all medicaments including natural alternatives. Many significant medicaments with their success rates have been mentioned in this paper. To increase the therapeutic success of pulpotomy procedure, it is necessary to identify a novel effective and preferably natural pulpotomy medicament.

Keywords: Medicament, primary teeth, pulpotomy


How to cite this article:
Jha S, Goel N, Dash BP, Sarangal H, Garg I, Namdev R. An update on newer pulpotomy agents in primary teeth: A literature review. J Pharm Bioall Sci 2021;13, Suppl S1:57-61

How to cite this URL:
Jha S, Goel N, Dash BP, Sarangal H, Garg I, Namdev R. An update on newer pulpotomy agents in primary teeth: A literature review. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Oct 27];13, Suppl S1:57-61. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/57/317694




   Introduction Top


Dental caries, a progressive bacterial damage to teeth brings about loss of tooth minerals that starts on the external surface of the tooth and can advance through the dentin to the pulp, eventually trading off essentialness of the tooth.[1] Vital pulp treatment has been progressively considered as a negligibly obtrusive methodology for the administration of teeth with excited pulps contrasted with the regular methodology of root canal treatment.[2] Pulpotomy is one of the vital pulp therapy techniques used for preserving decayed primary teeth with extensive caries but without evidence of radicular pathology, which if not performed will lead ultimately in extraction. The ideal qualities of any pulpotomy material should be bactericidal, innocuous to pulp and encompassing structures, advance healing of remaining radicular pulp without meddling with the physiologic root resorption and ought not have any toxicity.[3] Among, the pulpotomy medicaments, formocresol (FC) remains the gold standard of all the medicaments reported in the literature. Despite the high success rate, the use of FC has raised various concerns that includes its mutagenic, carcinogenic, and allergenic potentials.[4] The objective of this literature review is to determine the types of material used in pulpotomy.


   Formocresol Top


In 1930, Sweet introduced the FC pulpotomy technique. FC has successively become a popular pulpotomy medicament for primary teeth. It acts as both bactericidal and devitalizing agent.[1] El Meligy et al. at 12 months' follow-up found 100% clinical and 98.1% radiographic success rate with FC pulpotomy.[5] Concerns have been raised about the toxicity and potential carcinogenicity of FC in humans. Studies have demonstrated FC treated teeth shows systemic uptake of FC and produce defects in succedaneous teeth.[6]


   Calcium Hydroxide Top


In 1930, Herman presented calcium hydroxide as Calxyl, which was utilized for pulp capping, was likewise pursued for pulpotomy.[7] Calcium hydroxide pulpotomy in deciduous teeth commonly causes internal resorption.[8] Success rate of calcium hydroxide pulpotomy in primary teeth is comparatively less to that observed in permanent dentition.[9] However, calcium hydroxide is the material of choice for direct pulp capping (DPC) and Pulpotomy techniques in permanent teeth (Mc Donald 1996).


   Glutaraldehyde Top


S'Gravenmade in 1975 used glutaraldehyde and furthermore, expressed that glutaraldehyde can possibly supplant FC. Two percent buffered glutaraldehyde was found to be least effective as a pulpotomy agent when compared with ferric sulfate and mineral trioxide aggregate (MTA).[10],[11] Internal resorption has been found as inadequate fixation leaves a deficient barrier to subbase irritation.[12]


   Zinc Oxide Eugenol Top


Zinc oxide eugenol (ZOE) was the first in the field to be used for the preservation process. ZOE provides an effective seal thereby limiting microleakage and recurrent infection. James E. Berger 1965, observed active inflammatory reactions in all the teeth treated with ZOE as a pulpotomy medicament. The reactions varied from simple chronic to acute suppurative pulpitis. FC pulpotomy when performed by incorporating FC in the zinc oxide-eugenol subbase showed 99% clinical success rate.[13]


   Mineral Trioxide Aggregate Top


MTA is novel endodontic cement that was at first presented as material for root perforation repair by Mohmond Torabinajad Atlomalinda University in 1993. The use of MTA was recommended by the American Academy of Pediatric Dentistry for pulpotomies of primary teeth with typical pulps or reversible pulpitis when caries expulsion brings about pulp presentation or after a traumatic pulp exposure.[14] The presentation of MTA for pulpotomy defeated the downsides of FC, for example, its likely harmfulness, harsh nature, and tissue disturbance and irritation on contact with delicate tissue.[15] Farsi et al. found that pulpotomized essential molars treated with MTA had altogether more accomplishment than those treated with FC.[16]


   Biodentine Top


Biodentine became commercially available in 2009 (septodont) and that was especially designed as a “dentine replacement” material.[17] Various studies have reported a high success rate of biodentine used as a pulpotomy medicament, stating it as a positive and promising option for the current pulpotomy medicaments.[18] Nasseh et al. evaluated outcomes of biodentine pulpotomies in deciduous molars with physiologic root resorption and found 100% clinical and radiographic success rates at 6 and 12 months' follow-up.[19]


   Calcium Enriched Mixture Top


Calcium-enriched mixture (CEM) cement, a novel endodontic material also known as new endodontic cement was introduced to dentistry by Asgary et al. in 2006. Nosrat in 2012 compared MTA with CEM pulpotomy, result showed 100% clinical and radiographical success rate for both the groups at 6 and 12 months' follow-up.[20]


   Portland Cement Top


In 1824, Joseph Aspdin licensed an item purported Portland cement which was gotten from the calcination of the combination of limestones coming from Portland in England and silicon-argillaceous material.[21] Portland cement has procured interest as an alternate to MTA.[12] The number of studies used Portland cement as material of reference and showed that the only difference between Portland cement and MTA material is the bismuth oxide.[22] For the reason of its low cost, it is reasonable to consider port land cement as a possible substitute for MTA.[12]


   Sodium Hypochlorite Top


Sodium hypochlorite most popular endodontic irrigants seems to be an acceptable alternative for FC owing to its antimicrobial property and hemostatic agent. Kola SR (2019) showed promising results of 5% NaOCl as a primary molar pulpotomy agent.[23]


   Hydroxyapatite Top


The recently developed interest for nanotechnology in many fields, is producing interesting and imminent applications in dentistry for nanohydroxyapatite, which presents crystals ranging in size between 50 and 1000 nm.[24] Nanohydroxyapatite was used as pulpotomy and DPC agent in pig teeth by Shayegan et al.[25] Adlakha et al. in his study found 100% clinical and 80.33% radiographic success rate with hydroxyapatite crystal pulpotomy in deciduous molars.[26]


   Bioactive Glass Top


Bioactive glasses were first developed by Hench et al, which represents a group of reactive materials that are able to bond to mineralized bone tissue in physiological environment.[27] Haghgoo and Ahmadvand conducted a study to evaluate the pulpal response of of primary teeth after DPC with MTA and bioactive glass (BAG), result showed no significant difference between the two groups.[28] A major limitation of BAG is its biodegradable nature that depends on glass composition and environment pH. A highly reactive bioglass composition will degrade at a faster rate.[29]


   Platelet Concentrate Top


Platelet-rich fibrin (PRF) was first developed in France by Choukroun et al. in 2001. Mostafa AA (2018) performed pulpotomy using PRF and showed clinical success rate of 89.5% and radiographic success rate of 78.9%, and concluded that PRF can be used as alterantive pulpotomy agent to FC.[30]


   Theracal Light-Cured Top


In 2011, a light curable resin-modified tricalcium silicate (theracal light-cured) was introduced by Bisco Inc., Schamburg, Chicago, IL, USA.[31] When the chemical and physical properties of theracal were compared to MTA and calcium hydroxide, theracal displayed significantly higher calcium releasing ability and lower solubility than either MTA and calcium hydroxide.[32] Bakhtiar et al. compared theracal with biodentine and pro root MTA to see human pulp responses to partial pulpotomy and concluded overall, biodentine and MTA performed better than theracal when used as partial pulpotomy agent.[33]


   Propolis Top


Propolis, a natural resinous and balsamic substance, which in dentistry is used as mouth rinses, anti-cariogenic, in DPC, pulpotomy, endodontic therapy, root canal irrigant, intracanal medicament, as a storage media for avulsed tooth.[34] Carmen et al., (2007) compared the effectiveness of 10% propolis tincture and formocresol pulpotomy in primary in primary molars and showed that 10% propalis tincture was effective as FC.[35] Allergic reaction to propolis may be seen as contact cheilitis, contact stomatitis, perioral eczema, labial edema, oral pain, peeling of lips, and dyspnea.[34]


   Enamel Matrix Derivative Top


Enamel matrix derivative (EMD, Emdogain) has been advocated for the regeneration of dental tissues.[36] Emdogain gel (Straumann, Switzerland) has been successfully employed for pulpotomies in noninfected teeth in animal studies.[37] Yildirim et al. have suggested that clinical and radiographic success rate of EMD was similar to MTA, Portland cement and formocresol.[36]


   Chlorhexidine Polymer Top


Chlorhexidine is a popular and proven disinfectant to get rid of broad spectrum of oral microbiota. Chlorhexidine is loaded into polymer scaffold by electrospinning and placed as a pulp dressing following vital pulp therapy. Polyvinyl alcohol polymer of molecular weight 124,000 g/mol, 2% chlorhexidine gluconate and distilled water are used in the preparation of chlorhexidine-loaded scaffold.[38]


   3Mix-Tatins Top


3Mix-tatin has been used as a DPC and root canal filling material in primary teeth. It is composed of 3Mix (a combination of metronidazole, minocycline, and ciprofloxacin) and statin. The successful outcome of 3Mix-tatin could be attributed to the bio-inductive effect of simvastatin. 3Mix-tatin in a study by Jamali et al. showed success rate of 90.5% for pulpotomy of primary molars.[39]


   Bone Morphogenetic Protein Top


Bone morphogenic protein was used as pulpotomy agent by Nakashima in 1991.[40] Pulpotomy was performed in dogs teeth using bone morphogenic proetein-7. Apical and periapical responses were not satisfactory, also BMP-7 did not show any mineralised tissue deposition.[40]


   Enriched Collagen Top


Collagen in the field of dentistry is used as guided tissue regeneration, root conditioning, hemostatic, and wound dressing agent.[41] Michaeli Y (1984) studied pulp healing purpose in baboons after pulpotomy using an enriched collagen solution as a pulp dressing. The result induced 80% of teeth vital pulp and dentin bridges into the pulp chamber.[42],[43]


   Natural Alternatives Top


Many natural products such as Nigella sativa, curcuma longa, turmeric, thymus vulgaris, honey, Allium sativum oil, Aloe vera, acemannan have claimed to play a vital role and appear to be a feasible replacement to FC. However, higher level of evidence is needed to hold up its usage in pediatric dentistry.[4]


   Conclusion Top


For the success of pulpotomy technique it is important to investigate, diagnose, and select the medicament properly. Despite various drawbacks of FC, it is still most commonly used pulpotomy agents. Alternative medicaments have studied and used which has its own advantages and disadvantages. In replacement to FC various medicaments including MTA and natural products affirm to be a viable alternative. Till date, an ideal pulpotomy agent has not been recognized. Greater number of long-term studies with highest levels of evidence (randomized control trial) is required to determine the best medicament for pulpotomy of primary teeth.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chandrashekhar S, Shashidhar J. Formocresol, still a controversial material for pulpotomy: A critical literature review. J Restorative Dent 2014;2:114.  Back to cited text no. 1
    
2.
Galani M, Tewari S, Sangwan P, Mittal S, Kumar V, Duhan J. Comparative evaluation of postoperative pain and success rate after pulpotomy and root canal treatment in cariously exposed mature permanent molars: A randomized controlled trial. J Endod 2017;43:1953-62.  Back to cited text no. 2
    
3.
Taha NA, Abdelkhader SZ. Outcome of full pulpotomy using biodentine in adult patients with symptoms indicative of irreversible pulpitis. Int Endod J 2018;51:819-28.  Back to cited text no. 3
    
4.
Saikiran KV, Kamatham R, Sahiti PS, Nuvvula S. Pulpotomy medicaments in primary teeth: A literature review of natural alternatives. SRM J Res Dent Sci 2018;9:181.  Back to cited text no. 4
  [Full text]  
5.
El Meligy OA, Alamoudi NM, Allazzam SM, El-Housseiny AA. Biodentine™ versus formocresol pulpotomy technique in primary molars: A 12-month randomized controlled clinical trial. BMC Oral Health 2019;19:3.  Back to cited text no. 5
    
6.
Godhi B, Sood PB, Sharma A. Effects of mineral trioxide aggregate and formocresol on vital pulp after pulpotomy of primary molars: An in vivo study. Contemp Clin Dent 2011;2:296-301.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Kumar Praveen NH, Rashmi N, Bhaskar Vipin K, Mopkar Pujan P. Pulpotomy medicaments: Continued search for new alternatives-A review. Oral Health Dent Manag 2014;13:883-90.  Back to cited text no. 7
    
8.
Ravi GR, Subramanyam RV. Calcium hydroxide-induced resorption of deciduous teeth: A possible explanation. Dent Hypotheses 2012;3:90.  Back to cited text no. 8
  [Full text]  
9.
Silva LL, Cosme-Silva L, Sakai VT, Lopes CS, Silveira AP, Moretti Neto RT, et al. Comparison between calcium hydroxide mixtures and mineral trioxide aggregate in primary teeth pulpotomy: A randomized controlled trial. J Appl Oral Sci 2019;27:e20180030.  Back to cited text no. 9
    
10.
Goyal P, Pandit IK, Gugnani N, Gupta M, Goel R, Gambhir RS. Clinical and radiographic comparison of various medicaments used for pulpotomy in primary molars: A randomized clinical trial. Eur J Dent 2016;10:315-20.  Back to cited text no. 10
[PUBMED]  [Full text]  
11.
Raval R, Pandya P, Thummar KN, Prajapati D. Comparison of pulpotomy using ferric sulphate, glutaraldehyde and mta- A randomised controlled tria. Int J Community Health Med Res 2017;3:84-9.  Back to cited text no. 11
    
12.
Ahmed A, Sihag T, Khan SD, Almakrami MH, Alabbas AM, Alyami NM. A to Z pulpotomy agnets: Literature review. EC Dent Sci 2020;19:1-6.  Back to cited text no. 12
    
13.
Strange DM, Seale NS, Nunn ME, Strange M. Outcome of formocresol/ZOE sub-base pulpotomies utilizing alternative radiographic success criteria. Pediatr Dent 2001;23:331-6.  Back to cited text no. 13
    
14.
Khan J, El-Housseiny A, Alamoudi N. Mineral trioxide aggregate use in pediatric dentistry: A literature review. J Oral Hyg Health 2016;4.  Back to cited text no. 14
    
15.
Sushynski JM, Zealand CM, Botero TM, Boynton JR, Majewski RF, Shelburne CE, et al. Comparison of gray mineral trioxide aggregate and diluted formocresol in pulpotomized primary molars: A 6- to 24-month observation. Pediatr Dent 2012;34:120-8.  Back to cited text no. 15
    
16.
Farsi N, Alamoudi N, Balto K, Mushayt A. Success of mineral trioxide aggregate in pulpotomized primary molars. J Clin Pediatr Dent 2005;29:307-11.  Back to cited text no. 16
    
17.
Malkondu Ö, Karapinar Kazandağ M, Kazazoğlu E. A review on biodentine, a contemporary dentine replacement and repair material. Biomed Res Int 2014;2014:160951.  Back to cited text no. 17
    
18.
Poornima P, Shagun S, Roopa KB, Neena IE. Clinical and radiographic evaluation of primary molars treated with biodentine pulpotomy: A series of eight case reports. Niger J Exp Clin Biosci 2017;5:48.  Back to cited text no. 18
  [Full text]  
19.
N Nasseh H, El Noueiri B, Pilipili C, Ayoub F. Evaluation of biodentine pulpotomies in deciduous molars with physiological root resorption (Stage 3). Int J Clin Pediatr Dent 2018;11:393-4.  Back to cited text no. 19
    
20.
Nosrat A, Seifi A, Asgary S. Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: A randomized clinical trial. Int J Paediatr Dent 2013;23:56-63.  Back to cited text no. 20
    
21.
Viola NV, Tanomaru Filho M, Cerri PS. MTA versus Portland cement: Review of literature. RSBO Rev Bras Odontol 2011;8:446-52.  Back to cited text no. 21
    
22.
Bhagat D, Sunder RK, Devendrappa SN, Vanka A, Choudaha N. A comparative evaluation of ProRoot mineral trioxide aggregate and Portland cement as a pulpotomy medicament. J Indian Soc Pedod Prev Dent 2016;34:172-6.  Back to cited text no. 22
[PUBMED]  [Full text]  
23.
Kola SR, Reddy NV, Sneha T, Reddy MA, Niharika P, Kumar PJ. A histopathological comparison of pulpal response to formocresol and sodium hypochlorite used as pulpotomy medicaments: In primary teeth-A clinical trial. J Indian Soc Pedod Prev Dent 2019;37:198-204.  Back to cited text no. 23
[PUBMED]  [Full text]  
24.
Pepla E, Besharat LK, Palaia G, Tenore G, Migliau G. Nano-hydroxyapatite and its applications in preventive, restorative and regenerative dentistry: A review of literature. Ann Stomatol (Roma) 2014;5:108-14.  Back to cited text no. 24
    
25.
Shayegan A, Atash R, Petein M, Abbeele AV. Nanohydroxyapatite used as a pulpotomy and direct pulp capping agent in primary pig teeth. J Dent Child (Chic) 2010;77:77-83.  Back to cited text no. 25
    
26.
Adlakha VK, Chandna P, Joshi J, Thomas A, Singh N. A comparative evaluation of hydroxyapatite crystals and glutaraldehyde as agents for pulpotomy in deciduous molars. Int J Clin Pediatr Dent 2009;2:13-22.  Back to cited text no. 26
    
27.
Carvalho SM, Moreira CD, Oliveira AC, Oliveira AA, Lemos EM, Pereira MM. Bioactive glass nanoparticles for periodontal regeneration and applications in dentistry. In: Nanobiomaterials in Clinical Dentistry. New York: Elsevier; 2019. p. 351-83.  Back to cited text no. 27
    
28.
Haghgoo R, Ahmadvand M. Evaluation of pulpal response of deciduous teeth after direct pulp capping with bioactive glass and mineral trioxide aggregate. Contemp Clin Dent 2016;7:332-5.  Back to cited text no. 28
[PUBMED]  [Full text]  
29.
Hench LL, Hench WJ, Greenspan D. Bioglass: A short history and bibliography. J Aust Ceram Soc 2004;40:1-42.  Back to cited text no. 29
    
30.
Mostafa AA, El Hosary AM, Zahra MK. Clinical and radiographic evaluation of platelet-rich fibrin as a pulpotomy agent in primary molars. Tanta Dent J 2018;15:70.  Back to cited text no. 30
  [Full text]  
31.
Zaparde N, Gunda S, Patil A. Theracal… future of pulp capping ??? Int J Dev Res 2017;10:16338-42.  Back to cited text no. 31
    
32.
Wassel MO, Amin DH, Badran AS. Clinical, radiographic, and histologic evaluation of theracal pulpotomy in human primary teeth. Egypt Dent J 2017;63:2175-85.  Back to cited text no. 32
    
33.
Bakhtiar H, Nekoofar MH, Aminishakib P, Abedi F, Naghi Moosavi F, Esnaashari E, et al. Human pulp responses to partial pulpotomy treatment with TheraCal as compared with Biodentine and ProRoot MTA: A clinical trial. J Endod 2017;43:1786-91.  Back to cited text no. 33
    
34.
Malhotra S, Gupta VK. Use of propolis in pediatric dentistry. J Dent Allied Sci 2014;3:93.  Back to cited text no. 34
  [Full text]  
35.
Rodríguez WD, Carpio MH, Ramos MR, Milanés MG, Antúnez LN. Pulpotomies of dead pulps in temporal molars using 10% propolis tinction. Rev Cubana Estomatol 2007;44.  Back to cited text no. 35
    
36.
Yildirim C, Basak F, Akgun OM, Polat GG, Altun C. Clinical and radiographic evaluation of the effectiveness of formocresol, mineral trioxide aggregate, Portland cement, and enamel matrix derivative in primary teeth pulpotomies: A two year follow-up. J Clin Pediat Dent 2016;40:14-20.  Back to cited text no. 36
    
37.
Sabbarini J, Mounir M, Dean J. Histological evaluation of enamel matrix derivative as a pulpotomy agent in primary teeth. Pediatr Dent 2007;29:475-9.  Back to cited text no. 37
    
38.
Kalyan KS, Vinay C, Arunbhupathi, Uloopi KS, Chandrasekhar R, RojaRamya KS. Preclinical evaluation and clinical trial of chlorhexidine polymer scaffold for vital pulp therapy. J Clin Pediatr Dent 2019;43:109-15.  Back to cited text no. 38
    
39.
Jamali Z, Alavi V, Najafpour E, Aminabadi NA, Shirazi S. Randomized controlled trial of pulpotomy in primary molars using MTA and formocresol compared to 3Mixtatin: A novel biomaterial. J Clin Pediatr Dent 2018;42:361-6.  Back to cited text no. 39
    
40.
Ranly DM. Pulpotomy therapy in primary teeth: new modalities for old rationales. Pediatr Dent 1994;16:403.  Back to cited text no. 40
    
41.
da Silva LA, de Paula e Silva FW, Leonardo MR, Assed S. Pulpal and periapical response of dogs' teeth after pulpotomy and use of recombinant human bone morphogenetic protein-7 as a capping agent. J Dent Child (Chic) 2007;74:79-84.  Back to cited text no. 41
    
42.
Da Silva LA, Leonardo MR, Nelson-Filho P, Medeiros AS, Rossi MA. Pulp response of anionic lyophilized collagen matrix with or without hydroxyapatite after pulpotomy in dog's teeth. Mater Res 2006;9:175-80.  Back to cited text no. 42
    
43.
Michaeli Y. Enriched collagen solution as a pulp dressing in pulpotomized teeth in monkeys. Pediatr Dent 1984;6:243.  Back to cited text no. 43
    




 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Formocresol
   Calcium Hydroxide
   Glutaraldehyde
   Zinc Oxide Eugenol
    Mineral Trioxide...
   Biodentine
    Calcium Enriched...
   Portland Cement
   Sodium Hypochlorite
   Hydroxyapatite
   Bioactive Glass
   Platelet Concentrate
   Theracal Light-Cured
   Propolis
    Enamel Matrix De...
    Chlorhexidine Po...
   3Mix-Tatins
    Bone Morphogenet...
   Enriched Collagen
   Natural Alternatives
   Conclusion
    References

 Article Access Statistics
    Viewed1312    
    Printed20    
    Emailed0    
    PDF Downloaded119    
    Comments [Add]    

Recommend this journal