Abstract
Background: Early childhood caries is a serious public health problem. When caries extend to involve the pulp, various forms of pulp treatment are tried to stimulate tooth repair. Although pulpotomy is the treatment of choice for vital primary tooth pulp exposure but there is a trend among many dentists to perform pulpectomies in vital primary incisors. This study aimed to assess the effect of pulpotomy and pulpecomy in treatment of carious vital pulp exposure in primary incisors. Methods: We searched Pubmed and Cochrane library databases up to March, 2018, OpenGrey for grey literature and ClinicalTrials.gov for ongoing trials. Randomized controlled trials were included and assessed with Cochrane risk of bias tool . Primary outcomes were clinical failure and radiological failure.The effect sizes were calculated as risk ratios with 95%CI using the Mantel-Haenszel method. Results: Four trials were identified for qualitative assessment, only three trials were included in meta-analysis after exclusion of one trial due to its high risk of bias. The pooled results of the longest follow up period for clinical failure showed no statistically significant difference between pulpotomy and pulpectomy. The relative risk (RR) was e 2.69, 95% CI 0.76 to 9.58 for clinical failure.For radiographic failure, the sensitivity analysis showed RR 0.45, 95% CI 0.25 to 0.83 with a higher risk for radiographic failure in pulpectomy. The evidence was limited by the small number of trials included in the meta-analysis. Conclusions: Both pulpotomy and pulpectomy can be used successfully in the treatment of vital pulp exposure in primary incisors. Further high quality studies comparing between pulpotomy and pulpectomy in primary incisors with longer follow up period till exfoliation time are needed.
Highlights
Dental caries is an international public health challenge, especially among young children
Pulpotomy and root canal therapy have been both performed as techniques for the management of asymptomatic vital primary incisors with large carious lesions where removal of caries will lead to pulp exposure[20]
This study showed that there is no statistical significant difference in clinical success rates of pulpotomy and pulpectomy with different medicaments in the treatment of carious vital pulp exposure in primary incisors while radiographically, pulpectomy may have a higher risk for radiographic failure than pulpotomy and this refutes the misconception among some pediatric dentists that pulpotomy does not work in primary incisors
Summary
Dental caries is an international public health challenge, especially among young children. Childhood caries (ECC) is a serious public health problem in both developing and industrialized countries[1]. This study aimed to assess the effect of pulpotomy and pulpectomy in treatment of carious vital pulp exposure in primary incisors. Results: Four trials were identified for qualitative assessment, only three trials were included in meta-analysis after exclusion of one trial due to its high risk of bias. The pooled results of the longest follow up period for clinical failure showed no statistically significant difference between pulpotomy and pulpectomy. Conclusions: Both pulpotomy and pulpectomy can be used successfully in the treatment of vital pulp exposure in primary incisors. Further high quality studies comparing between pulpotomy and pulpectomy in primary incisors with longer follow up period till exfoliation time are needed
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