What is the most effective endodontic medicament for pulpotomies in immature permanent teeth?

Abstract

Data sources MEDLINE (via PubMed), EMBASE, the Cochrane library (CENTRAL) and the clinicaltrials.gov database were used as the data sources for the systematic review. Date restrictions were from database inception to October 2018 and only articles published in English were included. Hand searching of reference lists was carried out. Missing data was sought from authors if required for analysis.

Study selection Two independent researchers identified randomised controlled trials assessing the outcomes of pulpotomy procedures on vital permanent teeth with immature apices. Studies were only included if they reported clinical and radiographic success rates. After full text assessment, any disagreement between reviewers was resolved via discussion.

Data extraction and synthesis Data extraction was carried out using a table which was custom designed for this study. Accuracy of data was checked by a third reviewer. Strict criteria for healing were used for clinical and radiographic outcomes. Success rates were calculated for each intervention. Statistical testing on the data was completed using a fixed- or random-effect model depending on heterogeneity identified, using the i2 test. Results were presented as relative risks with 95% confidence intervals. Two independent reviewers assessed the quality of studies using the Cochrane risk of bias assessment tool.

Results Following screening of 1364 articles, five studies were included for qualitative analysis and two for quantitative analysis. All included studies were assessed as having a high risk of bias, which was attributed to the nature of the intervention and challenges in blinding the researcher. Four out of the five included studies were assessed as having a low risk of bias for detection, because of blinding of the investigator assessing the outcome. The remaining study had an unclear risk of bias for this parameter. No significant difference was detected between mineral trioxide aggregate (MTA) and calcium hydroxide (CH) at 6 months or 12 months post-treatment. MTA was also compared to platelet-rich fibrin (PRF), calcium-enriched mixture (CEM) and triple antibiotic paste (TAP) in individual studies with no statistically significant differences identified between groups. Significant clinical and radiographic differences were observed in favour of MTA and TAP compared to abscess remedy (AR), although this was noted as weak evidence.

Conclusions Based on the present evidence, there were similar success rates when using MTA, CH, CEM, RPF and TAP as medicaments for pulpotomies in the treatment of immature permanent teeth. More high-quality RCTs are needed in this field in future studies.