Comparative efficacy of medicaments or techniques for pulpotomy of primary molars: a network meta-analysis

Clinical and radiographic success of TheraCal versus Formocresol in primary teeth pulpotomy: A systematic review and meta-analysis

Background

Various dressing materials have been evaluated for pulpotomy of primary teeth. However, an ideal pulp dressing material has not been identified yet. This systematic review investigated the effectiveness of TheraCal compared to Formocresol in pulpotomy of primary teeth.

Materials and methods

This research was conducted in the form of a secondary study, with a systematic search of texts until 2023 in Scopus, Web of Science, PubMed and Google Scholar databases. The articles were selected based on the inclusion and exclusion criteria and, finally the search results were reported in the PRISMA chart. The quality of the studies was evaluated based on the NIH checklist. The extracted information was entered into Stata17 software. Heterogeneity was evaluated using Cochran's chi-square test and I2 statistics. Egger's tests were used to detect publication bias.

Results

After removing duplicate articles and articles that did not meet the inclusion criteria, 4 studies were selected for qualitative analysis. The odds' ratio of success rate between Formocresol and TheraCal pulpotomy for absence of the pain, abscess, Mobility, internal root resorption and bone radiolucency was obtained 1.12 (95 % CI: 0.32, 3.85, P = 0.86), 0.47 (95 % CI: 0.1, 2.14, P = 0.33), 0.82 (95 % CI: 0.21, 3.21, P = 0.78), 0.89 (95 % CI: 0.3, 2.67, P = 0.84), and 1.96 (95 % CI: 0.68, 5.62, P = 0.21) respectively.

Conclusion

The study results revealed that there was no significant difference in clinical and radiographic success between pulpotomy with TheraCal and Formocresol.

Efficacy of pulpotomy for permanent teeth with carious pulp exposure: A systematic review and meta-analysis of randomized controlled trials

This meta-analysis aims to assess the success rate of pulpotomy in the treatment of permanent teeth with carious pulp exposure and to compare the efficacy of different capping materials. Randomized controlled trials were searched in PubMed, EMBASE, Web of Science, Clinicaltrial.gov, and Cochrane Library until August 31, 2023. The pooled success rate was estimated in the overall population and in subgroups. Additional analyses comparing different capping materials using odds ratio (OR) and 95% confidence interval (95%CI) were performed. The certainty of evidence was graded using the GRADE approach. A total of 25 randomized trials with an average follow-up duration ≥ 12 months were finally included. The overall success rate of pulpotomy was 86.7% (95%CI: 82.0-90.7%). The success rate was not significantly affected by root development, pulpotomy type, and follow-up duration. Teeth with irreversible pulpitis had a relatively lower success rate than teeth with normal pulp or reversible pulpitis (82.4% [95%CI: 74.6-89.0%] vs 92.0% [95%CI: 87.9-95.4%], P = 0.013). Directly compared to conventional calcium hydroxide, mineral trioxide aggregate (88.2% vs 79.1%, OR = 2.41, 95%CI: 1.28-4.51, P = 0.006) and Biodentine (97.5% vs 82.9%, OR = 6.03, 95%CI: 0.97-37.6, P = 0.054) had higher successful rates. No significant difference between MTA and other biomaterials was found. The results were graded as very low to low certainty of evidence. In conclusion, pulpotomy is an effective treatment of permanent teeth with carious pulp exposure. Mineral trioxide aggregate and Biodentine can be recommended with more favorable outcomes as capping materials.

Clinical and Radiographic Evaluation of Diode and Er,Cr:YSGG Lasers as an Alternative to Formocresol and Sodium Hypochlorite for Pulpotomy Techniques in Primary Molars: A Randomized Controlled Clinical Trial

Background Pulpotomy treatment is one of the vital pulp therapies that can play a major role in the preservation of primary teeth until their natural exfoliation. The objective of this current clinical trial was to assess the clinical and radiographical success of diode and Er,Cr:YSGG lasers as a viable alternative to formocresol (FC) and sodium hypochlorite in the primary molar pulpotomies. Materials and methods Sixty primary molars were selected and randomly allocated to four groups. All treatment groups followed the same clinical protocol, except for the techniques used for hemostasis of the pulpotomy sites. In group A, hemostasis was achieved by applying a 1:5 dilution of FC solution, whereas in group B, 3% sodium hypochlorite was applied to achieve hemostasis. In group C, exposure to a diode laser of 940 nm was performed, whereas for group D, erbium laser irradiation with Er,Cr:YSGG laser of 2,780 nm was employed to achieve hemostasis. Radicular pulp stamps were covered with a 2 mm layer of mineral trioxide aggregate (MTA) paste. Stainless steel crowns were utilized for the final restorations of the primary teeth. The clinical and radiographic outcomes were evaluated at the six- and 12-month follow-up intervals. The investigation was registered with the ClinicalTrials.gov Protocol and Registration System (ID: NCT06002646). Results The overall clinical and radiographic success rates of pulpotomy were 92.3% for FC, 89% for sodium hypochlorite, 98.3% for a diode laser, and 98.7% for Er,Cr:YSGG lasers. There were no statistically significant differences among the four groups (p > 0.05). Conclusions Both the diode and Er,Cr:YSGG lasers showed outcomes comparable to those of FC and sodium hypochlorite. Therefore, they could be promising alternatives to primary tooth pulpotomies.

Hyaluronic acid as a pulpotomy material in primary molars: an up to 30 months retrospective study

BACKGROUND

The aim of this retrospective study was to determine the long-term clinical and radiographic success of our previous randomized clinical trial and to compare the success of hyaluronic acid, with the widely used formocresol and ferric sulphate agents.

METHODS

This retrospective study is the extension of the 1-year survey of our randomized clinical trial that had compared the effectiveness of a hyaluronic acid pulpotomy over formocresol and ferric sulphate pulpotomies and included clinical and radiographic evaluations with a follow-up period of over 24 months for 44 children who applied to our clinic between May 2019 and September 2019. Long-term clinical and radiographic data were obtained from the periodic files of our department, wherein each tooth's file was examined to identify any clinical and radiographic findings. Descriptive statistics and Pearson's chi-square tests were used to evaluate the data. Statistical significance was considered as p < 0.05.

RESULTS

The clinical and radiographic success rates of the hyaluronic acid, formocresol, and ferric sulphate groups were not statistically different at > 24 months. None of the teeth in the hyaluronic acid group showed any clinical findings at > 24 months.

CONCLUSIONS

Hyaluronic acid pulpotomies exhibited comparable success rates to formocresol and ferric sulphate materials spanning over 24 months examinations. Because of convenient accessibility and applicability of hyaluronic acid, it may be recommended as a promising alternative medicament for pulpotomy treatments of primary molars. However, further long-term follow-up human studies are needed to better understand the effect of hyaluronic acid on the dental pulp of human primary molars.

One-year radiographic and clinical performance of bioactive materials in primary molar pulpotomy: A randomized controlled trial

OBJECTIVES

Mineral Trioxide Aggregate (MTA) is considered the gold standard material for pulpotomy procedures. However, some drawbacks such as poor handling and long setting time are challenging when it is used as pulpotomy dressing in primary molars in children. Hence, the purpose of this study was to compare the radiographic and clinical performance of a premixed, fast setting bioceramic root repair material (BC RRM-F) with MTA in vital pulpotomy procedures of primary molars, with or without the added seal of a stainless steel crown (SSC).

METHODS

In this double blinded, four-arm, parallel group randomized contolled trial (RCT), 64 primary molars were randomly allocated to one of the four treatment groups: MTA (PDTM MTA WHITE)+SSC, MTA+GI (bulk fill glass ionomer with glass hybrid technology GC EQUIA Forte® HT), BC RRM-F+GI and BC RRM-F+SCC. All molars were evaluated clinically and radiographically according to the modified Zurn and Seale criteria at 1, 3, 6, and 12 months follow up. Multivariate cox regression models and Kaplan-Meier curves were used for survival analysis.

RESULTS

There was no statistically significant difference between the success of both pulp capping materials used. Overall survival analysis showed that using GI instead of SCC as a final restorative material was significantly associated with increased risk of failure.

CONCLUSIONS

TotalFill® BC RRM™ Fast Set Putty can be used as an alternative to MTA in primary molar pulpotomy. Regardless of the pulp capping material, one year survival of pulpotomized primary molars restored with SSC is higher compared to those restored with GC EQUIA Forte® HT.

CLINICAL SIGNIFICANCE

Clinicians' preference and cost effectiveness may justify the use of either material in primary molar pulpotomy. Parents insisting on tooth-colored restorations for their children's pulpotomized teeth cannot be told that the expectation for success is the same as those restored with SSC, even if calcium silicate-based pulp capping materials are used.