Pulp treatment for extensive decay in primary teeth.

Shetland NHS Board, Montfield Dental Clinic, Burgh Road, Lerwick, Shetland, UK, ZE1 OLA.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 02/2003; DOI: 10.1002/14651858.CD003220
Source: PubMed

ABSTRACT Dental decay in primary teeth remains a considerable health problem. Where decay extends to involve the dental pulp, pulp treatment techniques are often used to manage both symptomatic and symptom free teeth.
To assess the relative effectiveness of: various pulp treatment techniques in retaining primary molar teeth with decay involving the pulp for at least 12 months; pulp treatment techniques and extractions in avoiding long term sequelae.
We searched the Cochrane Oral Health Group's Trials Register (August 2002); the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2002); MEDLINE (January 1966 to August 2002); EMBASE (1980 to August 2002); Science Citation Index Expanded (1981 to August 2002); Social Science Citation Index (1981 to August 2002); Index to Scientific and Technical Proceedings (1982 to August 2002); System for Information on Grey Literature in Europe (August 2002). Key journals were handsearched. There was no restriction on language of publication.
Randomised or quasi-randomised controlled trials (RCTs) comparing different pulp treatment techniques (with each other, with extraction or with no treatment) for extensive decay in primary molar teeth. Primary outcomes were extractions following pulp treatment and long term effects.
Data extraction and quality assessment were carried out independently and in duplicate. Authors were contacted for additional information where necessary.
Eighty-two studies were identified but only three were suitable for inclusion. Nine studies meeting the inclusion criteria but with inappropriate study design or analysis are also described. Included trials investigated formocresol pulpotomy, ferric sulphate pulpotomy, electrosurgical pulpotomy or zinc oxide eugenol pulpectomy in symptom free, cariously exposed teeth. Data were unavailable on long term effects. Data on extraction following pulp treatment was available in all three studies and in two studies there was no statistically significant difference between the treatments. The difference seen in the other study, where more teeth treated by ferric sulphate pulpotomy were extracted compared to zinc oxide eugenol pulpectomy, must be viewed with caution.
Based on the available RCTs, there is no reliable evidence supporting the superiority of one type of treatment for pulpally involved primary molars. No conclusions can be made as to the optimum treatment or techniques for pulpally involved primary molar teeth due to the scarcity of reliable scientific research. High quality RCTs, with appropriate unit of randomisation and analysis are needed.

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    ABSTRACT: Maintaining deciduous teeth in function until their natural exfoliation is absolutely necessary. Vital pulp therapy (VPT) is a way of saving deciduous teeth. The most important factors in success of VPT are the early diagnosis of pulp and periradicular status, preservation of the pulp vitality and proper vascularization of the pulp. Development of new biomaterials with suitable biocompatibility and seal has changed the attitudes towards preserving the reversible pulp in cariously exposed teeth. Before exposure and irreversible involvement of the pulp, indirect pulp capping (IPC) is the treatment of choice, but after the spread of inflammation within the pulp chamber and establishment of irreversible pulpitis, removal of inflamed pulp tissue is recommended. In this review, new concepts in preservation of the healthy pulp tissue in deciduous teeth and induction of the reparative dentin formation with new biomaterials instead of devitalization and the consequent destruction of vital tissues are discussed.
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    ABSTRACT: Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the Web of Science, OpenGrey, the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry Platform.Study selectionTwo reviewers independently selected studies. Randomised controlled trials comparing different pulp interventions combining a pulp treatment technique and a medicament in primary teeth were considered.Data extraction and synthesisData abstraction and risk of bias assessment were carried out independently by two reviewers. The primary outcomes were clinical failure and radiological failure, as defined in trials, at six, 12 and 24 months. Pairwise meta-analysis using fixed-effect models was conducted with statistical heterogeneity being assessed using I2 coefficients.ResultsForty-seven trials involving 3910 teeth were included. All were small single centre studies. The overall level of evidence was low with only one trial having a low risk of bias, 20 a high risk and 26 unclear risk of bias.The 47 trials examined 53 different comparisons: 25 for pulpotomy, 13 for pulpectomy, 13 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.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.
    Evidence-Based Dentistry 12/2014; 15(4):100-1. DOI:10.1038/sj.ebd.6401056
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    ABSTRACT: A pulpotomia de molares decíduos com a pasta CTZ (cloranfenicol, tetraciclina, óxido de zinco e eugenol) tem sido utilizada em serviços públicos. Porém há carência de pesquisas que comprovem o custo-benefício de sua indicação. Neste estudo retrospectivo, verificou-se que a técnica foi considerada como sucesso em 29.1% dos casos. RESUMO A técnica da pulpotomia de molares decíduos com pasta CTZ (cloranfenicol, tetraciclina e óxido de zinco e eugenol) é considerada bem-sucedida pelo senso comum da equipe odontológica, porém há carência de pesquisas experimentais que sustentem a validade da sua indicação. Neste estudo retrospectivo, avaliou-se o desempenho clínico de pulpotomias com a pasta CTZ realizadas em molares decíduos de crianças de 4 a 11 anos atendidas em um Programa Saúde da Família. As crianças foram examinadas clinicamente por um cirurgião-dentista (anamnese, exame intra-bucal e radiográfico). A determinação da efetividade da técnica baseou-se na ausência de: dor, abscesso, fístula, mobilidade patológica, lesão óssea e reabsorção radicular patológica. Nos casos em que o decíduo havia esfoliado, avaliou-se a época de irrupção do pré-molar sucessor. Os dados foram analisados por estatística descritiva. Dos 40 casos observados, 11 entre 16 pré-molares sucessores irromperam em momento adequado para seu estágio de formação de raiz. Nenhum dente permanente irrompido apresentou alterações de forma e/ou cor. Vinte e quatro molares decíduos ainda estavam presentes na cavidade bucal de 18 crianças, restaurados adequadamente. Ao exame físico, verificou-se escurecimento da coroa (11/24), dor (2/24), abscesso (1/24), fístula (3/24) e mobilidade patológica (2/24). O exame radiográfico mostrou reabsorção externa patológica (14/24) e rarefação óssea peri-radicular (14/24). Associando os resultados dos exames físico e radiográfico dos molares decíduos tratados, considerou-se a efetividade da técnica da pulpotomia com CTZ em 29,1% (7 casos dos 24) após 10 a 39 meses de sua realização. PALAVRAS-CHAVE: Pulpotomia; Dente Decíduo; Programa Saúde da Família; pasta CTZ.


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Jun 5, 2014