Pulp treatment for extensive decay in primary teeth (Review)

Shetland NHS Board, Montfield Dental Clinic, Burgh Road, Lerwick, Shetland, UK, ZE1 OLA.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2003; 1(1):CD003220. DOI: 10.1002/14651858.CD003220
Source: PubMed


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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Available from: Chuen Albert Yeung, Jun 05, 2014
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    • "Although some recent meta-analyses [20] [21] [22] indicated that MTA and ferric sulfate may present similar or even better clinical or radiographic outcomes than formocresol, there is no comprehensive review for comparisons of different pulpotomy medications and techniques [23] [24]. Therefore, it is challenging for dentists to select the most appropriate medicaments, and the relative effectiveness of those treatments remains uncertain. "
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    ABSTRACT: Objective Pulpotomy is a common procedure to treat asymptomatic reversible pulpitis in primary molars. The aim of this study is to undertake a systematic review and a network meta-analysis to compare the clinical and radiographic outcomes of different pulpotomy procedures in primary molars. Data: Three authors performed data extraction independently and in duplicate using data collection forms. Disagreements were resolved by discussion. Sources: An electronic literature search was performed within MEDLINE (via PubMed), ScienceDirect, Web of Science, Cochrane, and ClinicalKey databases until December 2012. Medications for pulpotomy including formocresol, ferric sulfate, calcium hydroxide, and mineral trioxide aggregate (MTA), and laser pulpotomy are compared using Bayesian network meta-analyses. The outcome is the odds ratio for clinical and radiographic failure including premature tooth loss at 12 and 24 months after treatments amongst different treatment procedures. >37 studies were included in the systematic review, and 22 of them in the final network meta-analyses. After 18-24 months, in terms of treatment failure, the odds ratio for calcium hydroxide vs formocresol was 1.94 [95% credible interval (CI): 1.11, 3.25]; 3.88 (95% CI: 1.37, 8.61) for lasers vs formocresol; 2.16 (95% CI: 1.12, 4.31) for calcium hydroxide vs ferric sulfate; 3.73 (95% CI: 1.27, 11.67) for lasers vs ferric sulfate; 0.47 (95% CI: 0.26, 0.83) for MTA vs calcium hydroxide; 3.76 (95% CI: 1.39, 10.08) for lasers vs MTA. Conclusions After 18-24 months, formocresol, ferric sulfate, and MTA showed significantly better clinical and radiographic outcomes than calcium hydroxide and laser therapies in primary molar pulpotomies. Clinical significance: The network meta-analyses showed that MTA is the first choice for primary molar pulpotomies. However, if treatment cost is an issue, especially when the treated primary molars are going to be replaced by permanent teeth, ferric sulfate may be the choice.
    Journal of dentistry 09/2014; 42(9). DOI:10.1016/j.jdent.2014.02.001 · 2.75 Impact Factor
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    • "Evidence is lacking to determine which material is the most appropriate for primary teeth pulpotomies.[7] To make a decision, it is necessary to examine materials long term. "
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    ABSTRACT: Objective: The aim of this study is to evaluate four different pulpotomy medicaments in primary molars. Materials and Methods: A total of 147 primary molars with deep caries were treated with four different pulpotomy medicaments (FC: formocresol, FS: ferric sulfate, CH: calcium hydroxide, and MTA: mineral trioxide aggregate) in this study. The criteria for tooth selection for inclusion were no clinical and radiographic evidence of pulp pathology. During 30 months of follow-up at 6-month intervals, clinical and radiographic success and failures were recorded. The differences between the groups were statistically analyzed using the Chi-square test and Kaplan-Meier analysis. Results: At 30 months, clinical success rates were 100%, 95.2%, 96.4%, and 85% in the FC, FS, MTA, and CH groups, respectively. In radiographic analysis, the MTA group had the highest (96.4%), and the CH group had the lowest success rate (85%). There were no clinical and radiographic differences between materials (P > 0.05). Conclusions: Although there were no differences between materials, only in the CH group did three teeth require extraction due to further clinical symptoms of radiographic failures during the 30-month follow-up period. None of the failed teeth in the other groups required extraction during the 30-month follow-up period.
    European journal of dentistry 04/2014; 8(2):234-40. DOI:10.4103/1305-7456.130616
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    • "Además, Hill hizo controles regulares cada un año; nuestros controles en cambio, son irregulares , teniendo una mediana de seguimiento de 9 meses con un rango entre 0 a 43 meses. Nadin et al. (2003), considera como resultado aceptable de la terapia pulpar, la permanencia asintomática del diente tratado, más de 12 meses; por consiguiente, el pronóstico del diente con pulpotomía es bueno, y al igual que lo que dice la evidencia disponible (Hill) existe un 50% de posibilidades de que el tratamiento dure al menos 32 meses, cumpliendo así con el objetivo de mantener el diente en boca, lo que sustenta su uso como tratamiento cuyo fin es prevenir problemas mayores que requieran terapias más complejas , más costosas y con problemas adicionales que afecten el desarrollo normal del paciente pediátrico. "

    12/2013; 7(3):441-446. DOI:10.4067/S0718-381X2013000300017
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