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Children (Basel, Switzerland) May 2024This systematic review and meta-analysis aimed to evaluate the success rates of pulpotomy treatment for irreversible pulpitis in primary teeth. (Review)
Review
AIM
This systematic review and meta-analysis aimed to evaluate the success rates of pulpotomy treatment for irreversible pulpitis in primary teeth.
METHODS
This study was registered and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Relevant studies published between January 1980 and April 2023 were identified across eight online databases and two paediatric dentistry textbooks. Study selection, data extraction, and quality assessment were conducted by multiple investigators independently. Data analysis involved single-arm and two-arm meta-analyses, leave-one-out sensitivity analysis, meta-regression, and assessment of publication bias. The risks of bias were evaluated using the Cochrane Collaboration's assessment tools. The levels of evidence were determined using the Oxford Centre for Evidence-Based Medicine (OCEBM) tool.
RESULTS
Five primary studies were included. The weighted mean overall success rates at 6-month and 12-month follow-ups were 97.2% and 94.4%, respectively. Two-arm meta-analysis revealed no significant difference ( > 0.05) between the use of mineral trioxide aggregate (MTA) and non-MTA bioceramic-based materials as pulpotomy medicaments. The sample size of each study did not affect the degree of data heterogeneity. Egger's test revealed no significant publication bias.
CONCLUSIONS
Pulpotomy may be regarded as an alternative modality for treating primary teeth with irreversible pulpitis. Nevertheless, future well-designed trials and extended follow-up periods are warranted.
PubMed: 38790569
DOI: 10.3390/children11050574 -
Platelets Jul 2018The main purpose of the present systematic review was to evaluate the efficacy of platelet concentrates in pulpotomy of human teeth. Our systematic search included... (Review)
Review
The main purpose of the present systematic review was to evaluate the efficacy of platelet concentrates in pulpotomy of human teeth. Our systematic search included Medline, Embase, CINAHL, PsycINFO, Scopus, key journals, and review articles; the date of the last search was July 30, 2017. We graded the methodological quality of the studies by Cochrane Risk of Bias tool. Four randomized controlled trails were included in the present systematic review. The number of study participants ranged from 28 to 50, with a mean of 45.5. The age of study participants ranged between 4 and 25 years. In three of the included studies, platelet-rich fibrin (autologous) was used and in one study lyophilized freeze-dried platelet (allogenic) was used as pulpotomy material. Calcium hydroxide and mineral trioxide aggregate were used in control groups. The quality assessment rated three studies as being of fair quality and one study as poor quality. Two of the included studies showed a 100% success of pulpotomy with platelet concentrates and two studies showed more than 80% of success, but the difference between control group and platelet concentrates group was not statistically significant. To conclude, the number of publications that met all inclusion criteria was found to be very limited and no significant difference was reported in the studies comparing platelet concentrates with other materials in pulpotomy. The present results point to the need for high-quality randomized controlled trials in further research.
Topics: Blood Platelets; Humans; Pulpotomy
PubMed: 29537945
DOI: 10.1080/09537104.2018.1445844 -
Cureus Oct 2023The objective of this systematic review was to evaluate the current evidence of case reports where the treatment for permanent teeth with a diagnosis of irreversible... (Review)
Review
The objective of this systematic review was to evaluate the current evidence of case reports where the treatment for permanent teeth with a diagnosis of irreversible pulpitis was a full pulpotomy. This study was carried out by two reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic electronic search was carried out in the PubMed, Google Scholar, and Scopus databases until the year 2022 to find articles in English where the treatment for irreversible pulpitis in permanent teeth was a full pulpotomy. Literature reviews, in vitro or animal studies, abstracts, and unpublished data were excluded. The intervention, control, and outcome parameters were selected following the "Population, Interventions, Control, and Outcome" (PICO) guidelines. A total of 636 articles were found, and 14 articles were selected to be included in this review. The selected articles describe cases of full pulpotomies in mature permanent teeth with a diagnosis of irreversible pulpitis with a total of 34 (100%) successful cases, where 18 were men and 16 were women, with an average age of 19.20 ± 10.59 years and an average follow-up of 35.82 ± 26.39 months, with 12 months being the minimum follow-up time. The material used most frequently for obturation of the full pulpotomy was mineral trioxide aggregate in 16 cases (47.06%). Within the limitations of this review, full pulpotomy presents a high success rate regardless of the tooth, age, or sex as a treatment for teeth diagnosed with irreversible pulpitis.
PubMed: 37954774
DOI: 10.7759/cureus.46808 -
Quintessence International (Berlin,... Aug 2022To systematically evaluate and meta-analyze the short-and long-term clinical and radiologic failure rates of Biodentine versus formocresol as pulpotomy medicaments in... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically evaluate and meta-analyze the short-and long-term clinical and radiologic failure rates of Biodentine versus formocresol as pulpotomy medicaments in primary teeth.
DATA SOURCES
Relevant medical databases were searched until May 2021 for randomized controlled trials that used Biodentine and formocresol as pulpotomy medicaments in primary teeth with deep caries. Primary outcomes included clinical and radiologic failure rates at 12 months. Secondary outcomes were clinical and radiologic failure rates at 3, 6, 9, 13 to 24, and 25 to 48 months.
RESULTS
Nine randomized controlled trials (N = 626) with low risk of bias were included. Pooled analysis showed that compared to formocresol, Biodentine had significantly lower clinical failure rates (relative risk [RR] 0.16; 95% confidence interval (CI) 0.03 to 0.87; six randomized controlled trials; N = 394; GRADE, low) and radiologic failure rates (RR 0.19; 95% CI 0.08 to 0.49; six randomized controlled trials; N = 393; GRADE, low) at 12 months. Radiologic failure rates at 6 and 9 months were significantly lower in the Biodentine group compared to the formocresol group.
CONCLUSION
Compared to formocresol, Biodentine may be a superior medicament when used for pulpotomy in primary teeth. Adequately powered randomized controlled trials are needed to substantiate this evidence.
Topics: Calcium Compounds; Drug Combinations; Formocresols; Humans; Molar; Pulpotomy; Silicates; Tooth, Deciduous
PubMed: 35976738
DOI: 10.3290/j.qi.b3240043 -
Journal of Dentistry May 2024This paper evaluated the success rates of pulpotomy, compared its efficacy with non-surgical root canal treatment (NSRCT), evaluated different pulpotomy techniques, and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This paper evaluated the success rates of pulpotomy, compared its efficacy with non-surgical root canal treatment (NSRCT), evaluated different pulpotomy techniques, and analyzed the effectiveness of contemporary bioactive materials in managing irreversible pulpitis in mature permanent teeth.
DATA SOURCES
A comprehensive literature search was conducted across multiple databases including PubMed, Web of Science, Scopus, and the Cochrane Library. Search was conducted from the inception of each database to the present, adhering to PRISMA 2020 guidelines.
STUDY SELECTION
Studies were selected through a multi-step screening process, focusing on adult populations, randomized controlled trials, and single-arm trials.
DATA
Fifteen randomized controlled trials and eight single-arm trials were included. For a follow-up period of more than 24 months, pooled clinical success rate of pulpotomy was 92.9 % (95 %CI;82.1-99.0 %), whereas pooled radiographic success rate was 78.5 % (95 %CI;66.7-88.4 %). Meta-analyses showed that there was no significant difference in success rates between pulpotomy and NSRCT, between full and partial pulpotomy techniques, or between Mineral Trioxide Aggregate pulpotomy and Calcium Enriched Mixture pulpotomy. The results indicated comparable efficacy across these variables.
CONCLUSIONS
The study highlights the potential of less invasive treatments. Pulpotomy may be a viable alternative to NSRCT for managing irreversible pulpitis in mature permanent teeth. Limitations such as the low quality of some single-arm trials and the high risk of bias in some randomized controlled trials highlight the need for further research to standardize methodologies and broaden literature inclusion for a more comprehensive understanding of the efficacy of pulpotomy, considering the high success rates reported. Clinical Significance This quantitative systematic review recognizes the potential of full or partial pulpotomy as a viable treatment alternative to root canal therapy for managing irreversible pulpitis in mature permanent teeth. Future studies should aim for standardized protocols to validate these findings and improve patient treatment outcomes.
Topics: Adult; Humans; Aluminum Compounds; Calcium Compounds; Dentition, Permanent; Drug Combinations; Pulpitis; Pulpotomy; Randomized Controlled Trials as Topic; Root Canal Filling Materials; Root Canal Therapy; Silicates; Treatment Outcome; Controlled Clinical Trials as Topic
PubMed: 38461884
DOI: 10.1016/j.jdent.2024.104923 -
Australian Endodontic Journal : the... Apr 2024The purpose of this systematic review and meta-analysis is to conduct a comparative evaluation of partial and full pulpotomy techniques in cariously exposed teeth with... (Review)
Review
The purpose of this systematic review and meta-analysis is to conduct a comparative evaluation of partial and full pulpotomy techniques in cariously exposed teeth with symptoms indicative of symptomatic irreversible pulpitis. Databases such as PubMed, EMBASE, Cochrane, and Web of Science were searched. Studies evaluating and/or comparing clinical and/or radiographic success of partial and full pulpotomy in teeth diagnosed with irreversible pulpitis with a minimum of 12 months follow-up were included. The risk of bias (ROB) tool was used for the assessment of ROB. A meta-analysis was conducted to compare the healing outcome of partial and full pulpotomy. Three studies fulfilled the inclusion criteria, there was a low risk of bias in each of the five domains. Full pulpotomy had a higher success rate than partial pulpotomy, according to meta-analysis, but the difference was not statistically significant.
PubMed: 38566370
DOI: 10.1111/aej.12844 -
European Archives of Paediatric... Aug 2018This was to compare clinical and radiographic success rates of laser pulpotomy with those of other pulpotomy techniques in primary teeth. (Comparative Study)
Comparative Study Meta-Analysis
AIM
This was to compare clinical and radiographic success rates of laser pulpotomy with those of other pulpotomy techniques in primary teeth.
METHODS
PubMed, SCOPUS, EMBASE, Cochrane and ISI Web of Knowledge databases were searched electronically without time or language limitations. Clinical trials in which laser pulpotomy was compared with at least one other pulpotomy modality in primary teeth were selected. The bibliographic reference lists of eligible articles were also hand-searched. Odds ratios, risk differences and 95% confidence intervals were calculated with the aid of Comprehensive Meta-Analysis software (Version 2.2.050, Biostat, Englewood, NJ, USA). The methodological quality of articles included in the meta-analysis was determined using the Jadad scale.
RESULTS
Twelve pulpotomy studies were selected for systematic review and underwent data extraction. Of these studies, statistical analysis was conducted on 11. All clinical trials had low to moderate risks of methodological bias. The meta-analysis showed no significant differences in clinical and radiographic pulpotomy outcomes with laser compared with other techniques (p > 0.05). Likewise, no differences were found in the outcomes at 1, 3, 6, 9, 12 or ≥ 18 months (all p > 0.05).
CONCLUSIONS
For primary molar pulpotomy, the laser technique showed comparable clinical and radiographic results to other conventional pulpotomy medicaments, including formocresol and mineral trioxide aggregate.
Topics: Humans; Laser Therapy; Molar; Pulpotomy; Radiography; Tooth, Deciduous
PubMed: 30019125
DOI: 10.1007/s40368-018-0358-4 -
European Archives of Paediatric... Aug 2015The aim of this study was to evaluate the scientific evidence of pulpotomy in primary teeth comparing mineral troxide aggregate (MTA), calcium hydroxide, ferric... (Comparative Study)
Comparative Study Meta-Analysis Review
AIM
The aim of this study was to evaluate the scientific evidence of pulpotomy in primary teeth comparing mineral troxide aggregate (MTA), calcium hydroxide, ferric sulphate, and electrosurgery with formocresol.
METHODS
A systematic search using key words was conducted using seven databases up to December 10, 2013. Clinical articles in English, Portuguese and Spanish were selected, which were in accordance with the inclusion and exclusion criteria and the research objective of comparing whether pulpotomy performed with formocresol in primary teeth is more effective than other medicaments or techniques.
RESULTS
Out of the 12,515 publication initially identified, 30 clinical articles were included in the systematic review and analysed by four meta-analyses. The success rate of MTA (94.6 %) was higher than that of formocresol (87.4 %), with a statistically significant difference (OR = 0.39; 95 % CI = 0.25-0.62). Formocresol pulpotomy success was not statistically different from ferric sulphate or electrosurgery.
CONCLUSION
MTA was clinically and radiographically superior to formocresol for pulpotomy of primary teeth. The other alternatives to formocresol such as electrosurgery and ferric sulphate can be used instead of formocresol since they showed success similar to formocresol. In addition, there is no evidence to support calcium hydroxide for pulpotomies in primary teeth.
Topics: Aluminum Compounds; Calcium Compounds; Calcium Hydroxide; Drug Combinations; Electrosurgery; Ferric Compounds; Formocresols; Humans; Oxides; Pulpotomy; Root Canal Irrigants; Silicates; Tooth, Deciduous; Treatment Outcome
PubMed: 25833280
DOI: 10.1007/s40368-015-0174-z -
Journal of the American Dental... Feb 2024This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain.
STUDIES REVIEWED
The authors searched PubMed, Cochrane Library, Embase, and Latin American and Caribbean Health Sciences Literature databases for studies published through June 30, 2022. The authors included randomized clinical trials if they reported on the assessment of postoperative pain after direct pulp capping, partial pulpotomy, pulpotomy, or single-visit RCT. The authors assessed the frequency of no, mild, moderate, and severe postoperative pain. They conducted meta-analyses to compare postoperative pain after full pulpotomy (PULP) and RCT.
RESULTS
The qualitative synthesis included 57 studies, and the authors conducted meta-analysis of 3. PULP leads to more asymptomatic cases (relative risk [RR], 1.06; 95% CI, 1.01 to 1.11; P < .01; I = 67%) and to a lower occurrence of mild (RR, 0.89; 95% CI, 0.79 to 0.99; P < .04; I = 37%) and moderate (RR, 0.70; 95% CI, 0.51 to 0.95; P < .02; I = 57%) postoperative pain than RCT. The frequency of severe pain was very low for both vital pulp therapy and RCT. Moderate to severe postoperative pain was more common at 48 hours through 72 hours after RCT and up to 36 hours after PULP. Pain intensity after PULP was higher using calcium-enriched material compared with using mineral trioxide aggregate at 12, 18, and 36 hours (P < .001).
PRACTICAL IMPLICATIONS
PULP showed a significantly higher incidence of no pain and a lower incidence of mild and moderate pain than single-visit RCT. Clinical decisions for RCT or PULP should not be based on differences in postoperative pain. When analgesia is indicated, it probably should be limited to a short time after PULP.
Topics: Humans; Dental Pulp Cavity; Root Canal Therapy; Dental Care; Pulpotomy; Pain, Postoperative
PubMed: 38325970
DOI: 10.1016/j.adaj.2023.11.008 -
The Cochrane Database of Systematic... Aug 2014In children, dental caries is among the most prevalent chronic diseases worldwide. Pulp interventions are indicated for extensive tooth decay. Depending on the severity... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In children, dental caries is among the most prevalent chronic diseases worldwide. Pulp interventions are indicated for extensive tooth decay. Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. After treatment, the cavity is filled with a medicament.This is an update of a Cochrane review first published in 2003. The previous review found insufficient evidence regarding the relative efficacy of these interventions, combining one pulp treatment technique and one medicament.
OBJECTIVES
To assess the effects of different pulp treatment techniques and associated medicaments for the treatment of extensive decay in primary teeth.
SEARCH METHODS
We searched the Cochrane Oral Health Group's Trials Register (to 25 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 25 October 2013), EMBASE via OVID (1980 to 25 October 2013) and the Web of Science (1945 to 25 October 2013). We searched OpenGrey for grey literature and the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Eligible studies were randomised controlled trials comparing different pulp interventions combining a pulp treatment technique and a medicament in children with extensive decay involving dental pulp in primary teeth.
DATA COLLECTION AND ANALYSIS
Two review authors independently carried out data extraction and risk of bias assessment in duplicate. We contacted authors of randomised controlled trials for additional information if necessary. The primary outcomes were clinical failure and radiological failure, as defined in trials, at six, 12 and 24 months. We performed data synthesis with pairwise meta-analyses using fixed-effect models. We assessed statistical heterogeneity using by I(2) coefficients.
MAIN RESULTS
We included 47 trials (3910 randomised teeth) compared to three trials in the previous version of the review published in 2003. All trials were single centre and small sized (median number of randomised teeth 68). Overall, the risk of bias was low in only one trial with all other trials being at unclear or high risk of bias. The overall quality of the evidence was low. The 47 trials examined 53 different comparisons: 25 comparisons between different medicaments/techniques for pulpotomy, 13 comparisons between different medicaments for pulpectomy, 13 comparisons between different medicaments for direct pulp capping and two comparisons between pulpotomy and pulpectomy. Regarding pulpotomy, 14 trials compared mineral trioxide aggregate (MTA) with formocresol (FC). MTA reduced both clinical and radiological failures at six, 12 and 24 months, although the difference was not statistically significant. MTA also showed favourable results for all secondary outcomes measured, although again, differences between MTA and FC were not statistically significant (with the exception of pathological root resorption at 24 months and dentine bridge formation at six months). MTA showed favourable results compared with calcium hydroxide (CH) (two trials) for all outcomes measured, but the differences were not statistically significant (with the exception of radiological failure at 12 months). When comparing MTA with ferric sulphate (FS) (three trials), MTA had statistically significantly fewer clinical, radiological and overall failures at 24 months. This difference was not shown at six or 12 months.FC was compared with CH in seven trials and with FS in seven trials. There was a statistically significant difference in favour of FC for clinical failure at six and 12 months, and radiological failure at six, 12 and 24 months. FC also showed favourable results for all secondary outcomes measured, although differences between FC and CH were not consistently statistically significant across time points. The comparisons between FC and FS showed no statistically significantly difference between the two medicaments for any outcome at any time point.For all other comparisons of medicaments used during pulpotomies, pulpectomies or direct pulp capping, the small numbers of studies and the inconsistency in results limits any interpretation.
AUTHORS' CONCLUSIONS
We found no evidence to identify one superior pulpotomy medicament and technique clearly. Two medicaments may be preferable: MTA or FS. The cost of MTA may preclude its clinical use and therefore FS could be used in such situations. Regarding other comparisons for pulpectomies or direct pulp capping, the small numbers of studies undertaking the same comparison limits any interpretation.
Topics: Aluminum Compounds; Calcium Compounds; Calcium Hydroxide; Child; Child, Preschool; Controlled Clinical Trials as Topic; Dental Caries; Dental Cements; Dental Materials; Drug Combinations; Electric Stimulation Therapy; Ferric Compounds; Formocresols; Humans; Molar; Oxides; Pulpectomy; Pulpotomy; Randomized Controlled Trials as Topic; Silicates; Tooth, Deciduous; Zinc Oxide-Eugenol Cement
PubMed: 25099759
DOI: 10.1002/14651858.CD003220.pub2