Pulp treatment for extensive decay in primary teeth

• Published in: Cochrane database of systematic reviews 2018-05, Vol.5 (5), p.CD003220-CD003220
• Main Authors: Smaïl-Faugeron, Violaine, Glenny, Anne-Marie, Courson, Frédéric, Durieux, Pierre, Muller-Bolla, Michele, Fron Chabouis, Helene
• Format: Article
• Language: English
• Subjects: Aluminum Compounds - therapeutic use; Calcium Compounds - therapeutic use; Calcium Hydroxide - therapeutic use; Child; Child health; Child, Preschool; Controlled Clinical Trials as Topic; Dental Caries - therapy; Dental Cements - therapeutic use; Dental Materials - therapeutic use; Dentistry & oral health; Drug Combinations; Electric Stimulation Therapy; Ferric Compounds - therapeutic use; Formocresols - therapeutic use; Humans; Molar; ORAL HEALTH; Oxides - therapeutic use; Pulpectomy - methods; Pulpotomy - methods; Randomized Controlled Trials as Topic; Silicates - therapeutic use; Tooth, Deciduous; Treatment Failure; Zinc Oxide-Eugenol Cement - therapeutic use
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD003220.pub3

In children, dental caries (tooth decay) is among the most prevalent chronic diseases worldwide. Pulp interventions are indicated for extensive tooth decay. Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. After treatment, the cavity is filled with a medicament. Materials commonly used include mineral trioxide aggregate (MTA), calcium hydroxide, formocresol or ferric sulphate.This is an update of a Cochrane Review published in 2014 when insufficient evidence was found to clearly identify one superior pulpotomy medicament and technique. To assess the effects of different pulp treatment techniques and associated medicaments for the treatment of extensive decay in primary teeth. Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health Group's Trials Register (to 10 August 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2017, Issue 7), MEDLINE Ovid (1946 to 10 August 2017), Embase Ovid (1980 to 10 August 2017) and the Web of Science (1945 to 10 August 2017). OpenGrey was searched for grey literature. The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. We included randomised controlled trials (RCTs) comparing interventions that combined a pulp treatment technique with a medicament or device in children with extensive decay in the dental pulp of their primary teeth. Two review authors independently extracted data and assessed 'Risk of bias'. We contacted authors of RCTs for additional information when necessary. The primary outcomes were clinical failure and radiological failure, as defined in trials, at six, 12 and 24 months. We performed data synthesis with pair-wise meta-analyses using fixed-effect models. We assessed statistical heterogeneity by using I² coefficients. We included 40 new trials bringing the total to 87 included trials (7140 randomised teeth) for this update. All were small, single-centre trials (median number of randomised teeth = 68). All trials were assessed at unclear or high risk of bias.The 87 trials examined 125 different comparisons: 75 comparisons of different medicaments or techniques for pulpotomy; 25 comparisons of different medicaments for