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Quintessence International (Berlin,... 2021Objectives: This systematic review aimed to evaluate the clinical and radiographic outcomes of coronal and partial pulpotomies in mature permanent molars with cariously... (Meta-Analysis)
Meta-Analysis
Objectives: This systematic review aimed to evaluate the clinical and radiographic outcomes of coronal and partial pulpotomies in mature permanent molars with cariously exposed vital pulp. Method and materials: The protocol of the current review was registered in the PROSPERO database (CRD 42020190785). Articles published between January 1980 and June 2020 were searched in eight different online databases and six textbooks according to PRISMA guidelines. Eleven studies were included in the analysis of 1-year success rates, whereas five studies were included in the analyses of 2-year and > 2-year success rates for coronal pulpotomy. Two studies were included in the analyses of the 1-year and 2-year success rates for partial pulpotomy. The clinical and radiographic success rates were estimated using the DerSimonian-Laird random effect method. The risks of bias were evaluated using Cochrane RoB 2, ROBINS-I, and Newcastle-Ottawa scale assessment tools. Evidence levels were determined using the Oxford Centre for Evidence-Based Medicine (OCEBM) recommendation tool. The success rates using different pulp capping medicaments and restorative materials were analyzed using meta-regression analysis. Results: The clinical and radiographic success rates of coronal pulpotomy ranged between 92.2% and 99.4%, whilst for partial pulpotomy, the success rates ranged between 78.2% and 80.6%. Different pulp capping medicaments and restorative materials showed no significant effect on the success rates of coronal pulpotomy, but the former significantly (P < .05) affected the success rates of partial pulpotomy. Conclusion: Coronal and partial pulpotomies demonstrated a high success rate in treating cariously exposed vital pulp of mature permanent molars. Further well-designed studies with longer follow-up periods are required to validate these findings.
Topics: Dental Caries; Dental Materials; Dental Pulp Capping; Humans; Molar; Pulpotomy; Tooth, Deciduous; Treatment Outcome
PubMed: 33491388
DOI: 10.3290/j.qi.b912685 -
Journal of Endodontics Nov 2019The current systematic review and meta-analysis aimed to evaluate the success rate of partial pulpotomy in treating permanent posterior teeth with carious vital pulp... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The current systematic review and meta-analysis aimed to evaluate the success rate of partial pulpotomy in treating permanent posterior teeth with carious vital pulp exposure. A secondary aim was to assess the prognostic factors using a meta-regression.
METHODS
An electronic search was performed for studies from January 1950 to November 2018 in the following databases: PubMed, ScienceDirect, and Cochrane. All searches were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies evaluating the success rate of cariously exposed vital human permanent posterior teeth treated with a partial pulpotomy were selected. Only randomized clinical trials and prospective clinical studies were included for evaluation. The Newcastle-Ottawa Scale and the Cochrane Collaboration's tool were used to evaluate risk assessment.
RESULTS
From the 218 studies identified through the initial search, 11 studies qualified for the final analysis (5 randomized clinical trials and 6 prospective studies). The results of the meta-analysis indicate a success rate of 98% (confidence interval [CI]: 0.94-1), 96% (CI: 0.92-0.99), and 92% (CI: 0.83-0.97) after 6 months and 1 and 2 years of follow-up. Examining the probable prognostic factors using meta-regression analysis, only preoperative pulp status (P = .001) was identified as a significant factor, with studies including teeth with the presumptive diagnosis of irreversible pulpitis displaying significantly lower results. The final solution, pulp capping material, apex closure, and the age of the patient did not affect the treatment success rate (P > .05).
CONCLUSIONS
The available data suggest that a partial pulpotomy results in high success rates in treating cariously exposed permanent posterior teeth up to 2 years. Six months of monitoring can be considered an appropriate period when evaluating the success of a partial pulpotomy although more clinical and radiographic controls are essential to ensuring success.
Topics: Dental Caries; Dental Pulp Capping; Dental Pulp Exposure; Dentition, Permanent; Humans; Prospective Studies; Pulpotomy; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 31515048
DOI: 10.1016/j.joen.2019.07.005 -
Pediatric Dentistry Jan 2024The purpose of this study was to present an evidence-based guideline for primary teeth with deep caries or trauma requiring vital pulp therapies (VPT). A systematic... (Meta-Analysis)
Meta-Analysis
The purpose of this study was to present an evidence-based guideline for primary teeth with deep caries or trauma requiring vital pulp therapies (VPT). A systematic review/meta-analysis on vital primary teeth resulting from trauma or caries was conducted using GRADE to assess the certainty of evidence for clinical recommendations. A decision tree was provided for choosing VPTs. No articles on trauma VPT were found. For VPT in primary teeth with deep caries, indirect pulp treatment (IPT) or pulpotomy using the calcium silicate cement (mineral trioxide aggregate [MTA] or Biodentine) show increased success over using direct pulp capping (DPC) and other pulpotomies. Different liners do not affect IPT success (high certainty) or DPC capping agents' success (very low certainty) after 24 months. It is strongly recommended, with high certainty from 24-month data, that calcium silicate cement pulpotomy is preferred over formocresol, ferric sulfate, zinc oxide eugenol pulpotomy, and other pulpotomies. Using selective caries removal and IPT for deep caries is strongly recommended with moderate certainty over complete and stepwise removal. Statistically, this results in significantly fewer pulp exposures. No caries removal and Hall technique crown may be used when indicated (moderate certainty at 24 months). For vital primary incisors with deep caries, pulpotomy was significantly better statistically than pulpectomy. Teeth diagnosed with/without reversible pulpitis pain showed comparable success after 12 months of treatment by IPT or calcium silicate cement pulpotomy. The following had little or no significant effect on MTA pulpotomy success: coronal pulp removal methods; irrigation solution; method to control hemorrhage; base over MTA; treatment in one or two visits; anterior or posterior teeth. Indirect pulp treatment or calcium silicate cement pulpotomy is likely to increase vital pulp therapy success over other VPTs such as direct pulp capping and other pulpotomies after 24 months (moderate certainty).
Topics: Humans; Dental Care; Pulpotomy; Dental Pulp; Calcium; Dental Cements; Glass Ionomer Cements; Tooth, Deciduous; Calcium Compounds; Silicates
PubMed: 38449041
DOI: No ID Found -
Frontiers in Oral Health 2023Symptomatic irreversible pulpitis (SIP) or symptomatic apical periodontitis (SAP) are two painful conditions often warranting emergency treatment. The most common... (Review)
Review
Pain after emergency treatments of symptomatic irreversible pulpitis and symptomatic apical periodontitis in the permanent dentition: a systematic review of randomized clinical trials.
BACKGROUND
Symptomatic irreversible pulpitis (SIP) or symptomatic apical periodontitis (SAP) are two painful conditions often warranting emergency treatment. The most common emergency treatments supported by evidence are pulpotomy and pulpectomy and are normally performed under time-constrained circumstances. However, there is no strong evidence of which treatment suggested in literature a clinician can use to reduce endodontic pain effectively. Therefore, the aim of this systematic review is to investigate the present knowledge on postoperative pain related to the two types of emergency treatments available for treating SIP and SAP.
METHODS
Randomized controlled trials investigating postoperative pain after emergency treatments (pulpotomy and/or pulpectomy) on permanent dentition with signs and symptoms of SIP and/or SAP were searched in three major databases from 1978 until 2022. Risk of bias was assessed with Cochrane's tool.
RESULTS
Only five studies fulfilled the inclusion criteria. The included studies indicated that pulpotomy and pulpectomy are both suitable treatment options for SAP and SIP, as they provide sufficient alleviation of pain in permanent dentition. However, inconsistent results were found between the included trials on which emergency treatment is more effective in reducing pain. Cochrane's tool revealed that the studies had a low risk of bias. Limitations found in the design of the included randomized control trials decreased the level of evidence. None of the included studies accounted for essential confounding variables, such as factors affecting pain (including the psychological aspects). Moreover, possible non-odontogenic pain was not assessed, and therefore, it was not excluded; hence, affecting the internal validity of the studies.
CONCLUSION
There are controversies within the available randomized control trials on which treatment is most effective in reducing emergency pain. This could be due to some weaknesses in the design of the clinical trials. Thus, further well-designed studies are warranted to draw conclusions on which emergency treatment is more effective in reducing pain.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (CRD42023422282).
PubMed: 37920592
DOI: 10.3389/froh.2023.1147884 -
Indian Journal of Dental Research :... 2022Partial pulpotomy is a procedural intervention that can maintain the vitality of pulp during the management of traumatized permanent teeth with pulpal involvement. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Partial pulpotomy is a procedural intervention that can maintain the vitality of pulp during the management of traumatized permanent teeth with pulpal involvement.
AIM
To evaluate whether partial pulpotomy can be considered a reliable conservative treatment option for treating traumatized permanent anterior teeth with pulpal involvement.
METHODOLOGY
A computerized systematic search was performed in PubMed, Science Direct, Cochrane, and LILACS databases from 1980 to May 2021. Five studies were included in the final analysis. Quality assessment, Meta-analysis, and Publication bias of the studies were evaluated. This systematic review was registered in PROSPERO (ID - CRD42021262031).
RESULT
The comprehensive Meta-Analysis Software was used. The test of the heterogeneity was analysed using Cochran's Q statistics. The Q value was 7.186 (df = 6) with a P value of 0.3 and I as 16.5%. The studies were considered homogenous, and the fixed-effect model showed an overall point estimate of 0.89 with a 95% confidence interval (0.86-0.91). The Begg and Egger funnel plot indicated that there was no publication bias in the included studies.
CONCLUSION
Evidence indicates that partial pulpotomy may be considered a reliable definitive treatment option in asymptomatic traumatized permanent anterior teeth with exposed pulp rather than total pulpotomy.
Topics: Dental Pulp; Dental Pulp Capping; Dental Pulp Exposure; Dentition, Permanent; Humans; Pulpotomy; Treatment Outcome
PubMed: 36254961
DOI: 10.4103/ijdr.ijdr_1150_21 -
European Journal of Paediatric Dentistry Jun 2016To assess dental practice regarding the use of indirect pulp capping or pulpotomy in children with deep carious lesions approaching the pulp in primary teeth and to... (Review)
Review
AIM
To assess dental practice regarding the use of indirect pulp capping or pulpotomy in children with deep carious lesions approaching the pulp in primary teeth and to compare the efficacy of the two pulp treatments.
STUDY DESIGN
Systematic review. We searched the Cochrane Library, PubMed via MEDLINE, and EMBASE as well as the reference lists of included reports and ClinicalTrials.gov (for ongoing trials). Eligible studies were surveys of dental practice sent to dentists regarding the use of indirect pulp capping and pulpotomy in children with deep carious lesions approaching the pulp in primary teeth and any type of clinical study. Two review authors independently extracted data and assessed risk of bias in duplicate.
RESULTS
Of the 481 potentially eligible articles, 11 were included in the review: 8 described surveys of dental practice, 1 a non-randomised study, and 2 ongoing randomised trials. The surveys of dental practice showed an overall increase in the teaching and practice of indirect pulp capping in primary teeth. The non- randomised study found a statistically significant difference in favour of indirect pulp capping for clinical and radiological success at 3 years but with high overall risk of bias.
CONCLUSIONS
Despite the success rate of indirect pulp capping for treating deep carious lesions approaching the pulp in primary teeth, practitioners still hesitate to practice this technique because of lack of evidence and studies on this topic. Thus, for strong evidence, investigators are encouraged to conduct randomised trials comparing the efficacy of indirect pulp capping and pulpotomy for treating deep carious lesions approaching the pulp in primary teeth.
Topics: Dental Caries; Dental Pulp Capping; Humans; Pulpotomy; Tooth, Deciduous
PubMed: 27377108
DOI: No ID Found -
Cureus Jul 2022The major focus of this systematic review is to assess how effective partial pulpotomy is in managing carious vital pulp exposures in permanent posterior teeth. An... (Review)
Review
The major focus of this systematic review is to assess how effective partial pulpotomy is in managing carious vital pulp exposures in permanent posterior teeth. An electronic search for studies published between January 2011 and December 2021 was conducted using the following databases: PubMed, Scopus, Google Scholar, and Web of Science. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were followed during the search process. We selected human randomized clinical trials (RCTs) that investigated the success rate of partial pulpotomy for the treatment of cariously exposed vital permanent posterior teeth and the success rate of decayed exposed vital human permanent posterior dentition managed with a partial pulpotomy. Exclusively, randomized clinical trial papers were considered for assessment. The Cochrane Collaboration's tool was applied to assess the risk of bias. Four papers were selected for the final analysis from the 321 identified during the initial search. Our results showed that after six, 12, and 24 months of follow-up, the success rate was 94%, 93%, and 90%, respectively. The preoperative pulp state was the only significant predictive factor. Teeth with the presumptive diagnosis of irreversible pulpitis had the worse outcome. The treatment outcome was not influenced by the final restoration, pulp capping agent, apex closure, or patient age. Finally, the available data indicated that partial pulpotomy showed a high success rate in treating cariously exposed permanent posterior teeth for up to 24 months. When assessing the effectiveness of a partial pulpotomy, six months of maintenance is deemed adequate. To enhance treatment success, additional clinical and radiological measures are needed.
PubMed: 35936176
DOI: 10.7759/cureus.26573 -
The Cochrane Database of Systematic... Nov 2016There is a range of treatment options for the management of the pulp in extensively decayed teeth. These include direct and indirect pulp capping, pulpotomy or... (Review)
Review
BACKGROUND
There is a range of treatment options for the management of the pulp in extensively decayed teeth. These include direct and indirect pulp capping, pulpotomy or pulpectomy. If the tooth is symptomatic or if there are periapical bone changes, then endodontic treatment is required. However, if the tooth is asymptomatic but the caries is extensive, there is no consensus as to the best method of management. In addition, there has been a recent move towards using alternative materials and methods such as the direct or indirect placement of bonding agents and mineral trioxide aggregate.Most studies have investigated the management of asymptomatic carious teeth with or without an exposed dental pulp using various capping materials (e.g. calcium hydroxide, Ledermix, Triodent, Biorex, etc.). However, there is no long term data regarding the outcome of management of asymptomatic, carious teeth according to different regimens.
OBJECTIVES
This study aims to assess the effectiveness of techniques used to treat asymptomatic carious teeth and maintain pulp vitality.
SEARCH METHODS
Electronic searches of the following databases were undertaken: The Cochrane Oral Health Group's Trials Register (March 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 1), MEDLINE (1966 to week 4, February 2006), EMBASE (1974 to 13 March 2006), National Research Register (March 2006), Science Citation Index - SCISEARCH (1981 to March 2006). Detailed search strategies were developed for each database. Handsearching and screening of reference lists were undertaken. There was no restriction with regard to language of publication.
SELECTION CRITERIA
Studies included were randomised controlled trials (RCTs). Asymptomatic vital permanent teeth with extensive caries were included. Studies were those which compared techniques to maintain pulp vitality. Outcome measures included clinical success and adverse events.
DATA COLLECTION AND ANALYSIS
Data were independently extracted by three review authors. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Collaboration's statistical guidelines were followed.
MAIN RESULTS
Only four RCTs were identified. Interventions examined included: Ledermix, glycerrhetinic acid/antibiotic mix, zinc oxide eugenol, calcium hydroxide, Cavitec, Life, Dycal, potassium nitrate, dimethyl isosorbide, and polycarboxylate cement. Only one study showed a statistically significant finding; potassium nitrate/dimethyl isosorbide/polycarboxylate cement resulted in fewer clinical symptoms than potassium nitrate/polycarboxylate cement or polycarboxylate cement alone when used as a capping material for carious pulps.
AUTHORS' CONCLUSIONS
It was disappointing that there were so few studies which could be considered as being suitable for inclusion in this review. The findings from this review do not suggest that there should be any significant change from accepted conventional practice procedures when the pulp of the carious tooth is considered. Further well designed RCTs are needed to investigate the potential of contemporary materials which may be suitable when used in the management of carious teeth. It is recognised that it is difficult to establish the 'ideal' clinical study when ethical approval for new materials must be sought and strict attention to case selection, study protocol and interpretation of data is considered. It is also not easy to recruit sufficient numbers of patients meeting the necessary criteria.
Topics: Adult; Dental Caries; Dental Pulp; Dental Pulp Diseases; Humans; Randomized Controlled Trials as Topic
PubMed: 27892627
DOI: 10.1002/14651858.CD004484.pub3 -
Translational Pediatrics Apr 2022This study aimed to evaluate the effect of mineral trioxide aggregate (MTA) pulp capping for caries-exposed permanent teeth. However, the efficacy of MTA in the...
BACKGROUND
This study aimed to evaluate the effect of mineral trioxide aggregate (MTA) pulp capping for caries-exposed permanent teeth. However, the efficacy of MTA in the treatment of children's gums is still controversial, and different studies have shown different efficacy. Therefore, it is necessary to systematically review the efficacy and safety of MTA pulp incision in the treatment of pediatric caries using meta methods.
METHODS
We used meta-analysis to compare differences in the efficacy of MTA and calcium hydroxide (CH) for treating caries in permanent teeth. The mean treatment success rate of MTA for reversible and irreversible pulpitis groups was calculated, and the effect of apical opening condition and surgical type on success rate were investigated.
RESULTS
A total of 15 studies were included, and meta-analysis showed that there was a significant statistical difference between the MTA group and CH group in efficacy [odds ratio (OR) =1.87, 95% confidence interval (CI): 1.28, 2.73, P=0.001, I=63%, Z=3.25], success rate (OR =3.20, 95% CI: 1.93, 5.30, P<0.00001, I=0%, Z=4.52), influence of apical foramen condition on success rate (OR =1.77, 95% CI: 1.14, 2.73, P=0.01, I=15%, Z=2.56), and surgical procedure on success rate (OR =2.64, 95% CI: 1.65, 4.23, P<0.0001, I=45%, Z=4.05).
DISCUSSION
Our results showed that MTA pulpotomy was superior to CH. Nonclosure of apical openings and complete coronal pulpotomy may be more beneficial than partial pulpotomy.
PubMed: 35558967
DOI: 10.21037/tp-22-68 -
International Endodontic Journal Jun 2016The aim was to update a systematic review of pulp capping and partial pulpotomy by Olsson et al. (2006), by evaluating new evidence on formation of a hard tissue... (Review)
Review
The aim was to update a systematic review of pulp capping and partial pulpotomy by Olsson et al. (2006), by evaluating new evidence on formation of a hard tissue barrier after pulp capping and partial pulpotomy of experimental exposures in humans. PubMed (01-01-2005 to 01-03-2014) and CENTRAL were searched using specific keywords. Hand searches were made and the level of evidence for each included article was evaluated by the authors. The evidence of the conclusions was graded as strong, moderately strong, limited or insufficient. The initial search in PubMed yielded 215 abstracts. Hand searches of reference lists yielded no additional original scientific articles. After a selection process and interpretation, 22 articles were included and rated for level of evidence: no article was rated as high and seven as moderate. Overall the methodological quality of studies has improved since the previous systematic review was published in 2006. The conclusions are that there is limited scientific evidence that application of calcium hydroxide or mineral trioxide aggregate to an exposed pulp frequently results in formation of a hard tissue barrier, whereas adhesives or enamel matrix derivatives do not. There is insufficient scientific evidence that mineral trioxide aggregate promotes hard tissue formation more frequently than calcium hydroxide.
Topics: Aluminum Compounds; Calcium Compounds; Calcium Hydroxide; Dental Pulp Capping; Drug Combinations; Humans; Oxides; Pulpotomy; Silicates; Treatment Outcome
PubMed: 26059916
DOI: 10.1111/iej.12480