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The Journal of Evidence-based Dental... Dec 2022To determine the clinical performance of light-cured calcium silicate-based cement for direct or indirect pulp capping. The research question was as follows: in teeth... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To determine the clinical performance of light-cured calcium silicate-based cement for direct or indirect pulp capping. The research question was as follows: in teeth with deep caries lesions, does the use of resin-modified calcium silicate-containing composites improve the radiological success and prevent irreversible pulpitis and pulpal necrosis compared with other pulp-capping agents?
MATERIALS AND METHODS
The following databases were screened until September 2021: PubMed, Web of Science, Scielo, Scopus, Embase, and The Cochrane Library. Randomized clinical trials reporting the clinical evaluation of a resin-modified calcium silicate material as an agent for pulp therapy were included. Meta-analysis was performed using the Rev Manager v5.4.1 software. The risk difference and 95% confidence interval of the dichotomous outcome (restoration failure or success) were calculated for comparison.
RESULTS
Ten studies were considered for qualitative analysis and meta-analysis. Studies evaluating the performance of light-cured calcium silicate-based cement from 1 month to a maximum follow-up period of 36 months and comparing it with the performance of CaOH, mineral trioxide aggregate, or Biodentine were included. In the global analysis for direct pulp capping at 6-month follow-up, no statistical differences were observed between the experimental group using the light-cured calcium silicate-based cement and control group (P = .28). However, at 12-month follow-up, global analysis favored the control group (P < .001). For indirect pulp capping, at 6- and 24-month follow-ups, no statistically significant differences were observed between the experimental and control groups (P = .88; P = .21).
CONCLUSIONS
Light-cured calcium silicate-based cement showed a limited clinical performance as a direct pulp capping agent, especially when evaluated in the long term. However, using it as an indirect pulp capping agent may be a reliable and easy-to-use option for restoring teeth with deep caries.
CLINICAL SIGNIFICANCE
This systematic review provides evidence that supports the use of light-cured calcium silicate-based cement as an indirect pulp capping agent.
Topics: Humans; Pulp Capping and Pulpectomy Agents; Dental Pulp Capping; Silicate Cement; Glass Ionomer Cements; Dental Cements; Composite Resins
PubMed: 36494107
DOI: 10.1016/j.jebdp.2022.101776 -
Journal of Conservative Dentistry : JCD 2015To systematically review the anesthetic success rates of inferior alveolar nerve block (IANB) injection technique alone with that of combination of IANB and supplemental... (Review)
Review
AIM
To systematically review the anesthetic success rates of inferior alveolar nerve block (IANB) injection technique alone with that of combination of IANB and supplemental infiltration (SI) technique when used for pulpal anesthesia of mandibular posterior teeth with irreversible pulpitis during endodontic treatment.
SETTINGS AND DESIGN
The study follows a longitudinal study design involving original research.
MATERIALS AND METHODS
Electronic databases were systematically searched for randomized controlled clinical studies. Studies were selected by predefined inclusion and exclusion criteria.
STATISTICAL ANALYSIS USED AND RESULT
The statistical analysis used was based on the results of the original research. All the included studies showed that there is the difference in the values comparing the two techniques, but the data are not statistically significantly different.
CONCLUSION
Based on this review, the better anesthetic efficacy of the SI was observed.
PubMed: 26069400
DOI: 10.4103/0972-0707.157238 -
Journal of Dentistry Jan 2016This systematic review was performed to evaluate the clinical outcome of coronal pulpotomy treatment to manage carious vital pulp exposure in permanent posterior teeth... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This systematic review was performed to evaluate the clinical outcome of coronal pulpotomy treatment to manage carious vital pulp exposure in permanent posterior teeth with closed root apices.
DATA/SOURCES
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used. A search of articles published between 1960 January and 2015 July was conducted in PubMed, EMBASE, and CENTRAL databases.
STUDY SELECTION
Only studies that performed full coronal pulpotomy for carious vital pulp exposure of permanent posterior teeth and had clinical and radiographic assessments during at least one-year follow-up were qualified for data analyses. The weighted mean success rate (WSR) was the primary outcome and estimated using DerSimonian-Laird random effects model. Out of 299 articles, six studies were included for the analysis of one-year WSR, and five studies were included in the analysis of two-year WSR. The one-year and two-year WSR were 94% (95% confidence interval (CI): [90,99]) and 92% (CI: [84,100]) respectively. Differences in pulp capping and restoration materials did not significantly affect success rates (Two-year WSR in the MTA and MTA-like products group vs. the calcium hydroxide group: 92% (CI: [85,99]) vs. 88% (CI: [76,100]); the amalgam group vs. the composite group: 92% (CI: [81,100]) vs. 93% (CI: [81,100])).
CONCLUSIONS
Generally, full coronal pulpotomy had a favorable success rate in treating carious vital pulp exposure of permanent mature teeth with closed root apices. More studies with control group of root canal treated teeth and longer follow-up periods are needed.
CLINICAL SIGNIFICANCE
Coronal pulpotomy treatment can be considered as an intermediate treatment option in managing carious vital pulp exposures of permanent teeth with closed root apices. This option may also serve as a substitute to extraction when root canal treatment cannot be performed for low income and uninsured patients or in underserved areas.
Topics: Dental Pulp Capping; Dental Pulp Exposure; Humans; Pulp Capping and Pulpectomy Agents; Pulpitis; Pulpotomy; Treatment Outcome
PubMed: 26687672
DOI: 10.1016/j.jdent.2015.12.005 -
International Endodontic Journal Oct 2018This study aimed to compare the effectiveness of mepivacaine and lidocaine for pulpal anaesthesia and pain control when administered via an inferior alveolar nerve block... (Comparative Study)
Comparative Study Meta-Analysis
This study aimed to compare the effectiveness of mepivacaine and lidocaine for pulpal anaesthesia and pain control when administered via an inferior alveolar nerve block during the root canal treatment of mandibular molars in patients with symptomatic irreversible pulpitis. A research protocol was developed and registered in PROSPERO. The systematic search was conducted during May 2017 in eight databases. The studies were selected based on inclusion and exclusion criteria. Two examiners analysed the sample independently, decided the eligibility for inclusion and classified the articles according to their quality. Statistical analysis was performed with Mantel-Haenszel and I-square (I ) tests considering a confidence interval of 95%. The initial sample consisted of 1130 articles, out of which four were eligible. The articles were published between 1993 and 2016. For both pulpal anaesthesia and pain control, there was no significant difference between mepivacaine and lidocaine (P = 0.843, I = 0%, and P = 0.183, I = 21.1%, respectively). Mepivacaine and lidocaine were similarly effective for pulpal anaesthesia and pain control after inferior alveolar nerve blocks for root canal treatment.
Topics: Anesthesia, Dental; Anesthetics, Local; Humans; Lidocaine; Mepivacaine; Nerve Block; Pain Management; Pulpitis
PubMed: 29577321
DOI: 10.1111/iej.12926 -
Molecules (Basel, Switzerland) Jul 2021A wide range of mediators are released from the pulp tissue because of bacterial invasion which causes inflammation. Interleukins (ILs) and matrix metalloproteinases...
A wide range of mediators are released from the pulp tissue because of bacterial invasion which causes inflammation. Interleukins (ILs) and matrix metalloproteinases (MMPs) have a leading role in initiating and spreading of inflammation because of their synergic action. Biomarkers such as ILs and MMPs can be identified via several methods, establishing the inflammatory response of the dental pulp. The aim of this systematic review is to evaluate the levels of ILs and/or MMPs in human dental pulp. PubMed, OVID, Cochrane, Scopus, Web of Science and Wiley online library databases were searched for original clinical studies. After applying inclusion and exclusion criteria, a quality assessment of studies was performed based on a modified Newcastle-Ottawa scale. In the review were included articles that evaluated the presence of ILs and/or MMPs in pulp tissue using enzyme-linked immunosorbent assay (ELISA) or western blot or multiplex assay. Six articles were included in the present synthesis. Although various diagnostic methods were used, statistically significant higher levels of ILs and/or MMPs were mostly found in the experimental groups compared to healthy pulp samples. The biomarkers studied can be a promising tool to evaluate pulp tissue health or even in pulpitis treatment.
Topics: Dental Pulp; Humans; Inflammation; Interleukins; Matrix Metalloproteinases
PubMed: 34299403
DOI: 10.3390/molecules26144129 -
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 -
Journal of the American Dental... Feb 2020The authors of this systematic review and meta-analysis aimed to evaluate the effect of different anesthetics on the efficacy of inferior alveolar nerve block (IANB) in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The authors of this systematic review and meta-analysis aimed to evaluate the effect of different anesthetics on the efficacy of inferior alveolar nerve block (IANB) in patients with irreversible pulpitis.
TYPES OF STUDIES REVIEWED
The authors conducted a search of MEDLINE databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature, and Brazilian Library of Dentistry). There was no restriction on publication year or idiom. The gray literature was also explored. The authors included only randomized clinical trials that compared different anesthetics in the efficacy of IANB in patients with irreversible pulpitis. The risk of bias was evaluated by using the Cochrane Collaboration's tool. A random-effects Bayesian mixed treatment comparison model was used to compare different anesthetic solutions in randomized clinical trials with low or unclear risk of bias. Heterogeneity was assessed by using Cochran Q test and I statistics. Quality of evidence was assessed by using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
A total of 7,981 studies were identified; only 16 met the eligibility criteria, and they were all meta-analyzed. A significant difference was observed in the pair lidocaine versus articaine, with higher success with articaine (risk ratio, 0.76; 95% confidence interval, 0.63 to 0.88) in the mixed treatment comparison analysis, as this comparison was graded as high-quality evidence. The probability of success for each treatment was 73% for articaine, 57% for prilocaine, 55% for mepivacaine, 53% for bupivacaine, and 12% for lidocaine. This ranking was considered high quality of evidence.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
The use of articaine can increase the IANB success rate in patients with irreversible pulpitis. Among the anesthetic solutions, lidocaine was the least effective.
Topics: Anesthesia, Dental; Anesthetics, Local; Bayes Theorem; Brazil; Double-Blind Method; Humans; Lidocaine; Mandibular Nerve; Nerve Block; Pulpitis
PubMed: 31813471
DOI: 10.1016/j.adaj.2019.09.002 -
The Cochrane Database of Systematic... Dec 2013Irreversible pulpitis, which is characterised by acute and intense pain, is one of the most frequent reasons that patients attend for emergency dental care. Apart from... (Review)
Review
BACKGROUND
Irreversible pulpitis, which is characterised by acute and intense pain, is one of the most frequent reasons that patients attend for emergency dental care. Apart from removal of the tooth, the customary way of relieving the pain of irreversible pulpitis is by drilling into the tooth, removing the inflamed pulp (nerve) and cleaning the root canal. However, a significant number of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis.
OBJECTIVES
To assess the effects of systemic antibiotics for irreversible pulpitis.
SEARCH METHODS
We searched the Cochrane Oral Health Group's Trials Register (to 5 September 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9); MEDLINE via OVID (1946 to 5 September 2013); EMBASE via OVID (1980 to 5 September 2013) and the US National Institutes of Health Trials Register (http://clinicaltrials.gov). There were no language restrictions in the searches of the electronic databases.
SELECTION CRITERIA
Randomised controlled trials which compared pain relief with systemic antibiotics and analgesics, against placebo and analgesics in the acute preoperative phase of irreversible pulpitis.
DATA COLLECTION AND ANALYSIS
Two review authors screened studies and extracted data independently. We assessed the quality of the evidence of included studies using GRADEPro software. Pooling of data was not possible and a descriptive summary is presented.
MAIN RESULTS
One trial assessed at low risk of bias, involving 40 participants was included in this update of the review. The quality of the body of evidence was rated low for the different outcomes. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the seven-day study period. There was insufficient evidence to claim or refute a benefit for penicillin for pain intensity. There was no significant difference in the mean total number of ibuprofen tablets over the study period: 9.2 (standard deviation (SD) 6.02) in the penicillin group versus 9.6 (SD 6.34) in the placebo group; mean difference -0.40 (95% confidence interval (CI) -4.23 to 3.43; P value = 0.84). This applied equally for the mean total number of Tylenol tablets: 6.9 (SD 6.87) used in the penicillin group versus 4.45 (SD 4.82) in the placebo group; mean difference 2.45 (95% CI -1.23 to 6.13; P value = 0.19). Our secondary outcome on reporting of adverse events was not addressed in this study.
AUTHORS' CONCLUSIONS
This systematic review which was based on one low powered small sample trial assessed as a low risk of bias, illustrates that there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics. The results of this review confirm the necessity for further larger sample and methodologically sound trials that can provide additional evidence as to whether antibiotics, prescribed in the preoperative phase, can affect treatment outcomes for irreversible pulpitis.
Topics: Acetaminophen; Analgesics, Non-Narcotic; Anti-Bacterial Agents; Humans; Ibuprofen; Pain Measurement; Penicillins; Pulpitis; Randomized Controlled Trials as Topic; Toothache
PubMed: 24353116
DOI: 10.1002/14651858.CD004969.pub3 -
International Journal of Antimicrobial... Nov 2016Infected root canal or acute apical abscess exudates can harbour several species, including Fusobacterium, Porphyromonas, Prevotella, Parvimonas, Streptococcus,... (Meta-Analysis)
Meta-Analysis Review
Infected root canal or acute apical abscess exudates can harbour several species, including Fusobacterium, Porphyromonas, Prevotella, Parvimonas, Streptococcus, Treponema, Olsenella and not-yet cultivable species. A systematic review and meta-analysis was performed to assess resistance rates to antimicrobial agents in clinical studies that isolated bacteria from acute endodontic infections. Electronic databases and the grey literature were searched up to May 2015. Clinical studies in humans evaluating the antimicrobial resistance of primary acute endodontic infection isolates were included. PRISMA guidelines were followed. A random-effect meta-analysis was employed. The outcome was described as the pooled resistance rates for each antimicrobial agent. Heterogeneity and sensitivity analyses were performed. Subgroup analyses were conducted based upon report or not of the use of antibiotics prior to sampling as an exclusion factor (subgroups A and B, respectively). Data from seven studies were extracted. Resistance rates for 15 different antimicrobial agents were evaluated (range, 3.5-40.0%). Lower resistance rates were observed for amoxicillin/clavulanic acid and amoxicillin; higher resistance rates were detected for tetracycline. Resistance rates varied according to previous use of an antimicrobial agent as demonstrated by the subgroup analyses. Heterogeneity was observed for the resistance profiles of penicillin G in subgroup A and for amoxicillin, clindamycin, metronidazole and tetracycline in subgroup B. Sensitivity analyses demonstrated that resistance rates changed for metronidazole, clindamycin, tetracycline and amoxicillin. These findings suggest that clinical isolates had low resistance to β-lactams. Further well-designed studies are needed to clarify whether the differences in susceptibility among the antimicrobial agents may influence clinical responses to treatment.
Topics: Anti-Infective Agents; Bacteria; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Pulpitis
PubMed: 27742205
DOI: 10.1016/j.ijantimicag.2016.08.018 -
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