Primary molar pulpotomy: a systematic review and network meta-analysis

Po-Yen Lin; Hsueh-Szu Chen; Yu-Hsiang Wang; Yu-Kang Tu

doi:10.1016/j.jdent.2014.02.001

Primary molar pulpotomy: a systematic review and network meta-analysis

J Dent. 2014 Sep;42(9):1060-77. doi: 10.1016/j.jdent.2014.02.001. Epub 2014 Feb 7.

Authors

Po-Yen Lin¹, Hsueh-Szu Chen², Yu-Hsiang Wang³, Yu-Kang Tu⁴

Affiliations

¹ Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.
² Department of Dentistry, Taiwan Adventist Hospital, Taipei, Taiwan.
³ Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.
⁴ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: yukangtu@ntu.edu.tw.

PMID: 24513112
DOI: 10.1016/j.jdent.2014.02.001

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]; 3.38 (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.

Keywords: Network meta-analysis; Primary molar; Pulpotomy; Randomized controlled trials; Systematic review.

Publication types

Comparative Study
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Aluminum Compounds / therapeutic use
Calcium Compounds / therapeutic use
Calcium Hydroxide / therapeutic use
Drug Combinations
Ferric Compounds / therapeutic use
Formocresols / therapeutic use
Humans
Laser Therapy / methods
Molar / pathology*
Oxides / therapeutic use
Pulpitis / therapy
Pulpotomy / methods*
Root Canal Irrigants / therapeutic use
Silicates / therapeutic use
Tooth, Deciduous / pathology*
Treatment Outcome

Substances

Aluminum Compounds
Calcium Compounds
Drug Combinations
Ferric Compounds
Formocresols
Oxides
Root Canal Irrigants
Silicates
mineral trioxide aggregate
formocresol
ferric sulfate
Calcium Hydroxide