Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

828 questions · 1,007 findings · 63 reviews · All outcomes

No studies found 110 · 10.9%GRADE not reported 709 · 70.4%Very low 84 · 8.3%Low 70 · 7%Moderate 33 · 3.3%High 1 · 0.1%

4% articaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) · Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which…

It is very uncertain whether 4% articaine, 1:200,000 epinephrine changes speed of onset of anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:100,000 epinephrine (very low certainty).

1 finding from 1 review

0.5% bupivacaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) · Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which…

0.5% bupivacaine, 1:200,000 epinephrine showed no clear difference in success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:100,000 epinephrine (low certainty).

1 finding from 1 review

4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) · Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which…

It is very uncertain whether 4% articaine, 1:100,000 epinephrine changes speed of onset of anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:100,000 epinephrine (very low certainty).

1 finding from 1 review

4% articaine plain vs 4% articaine, 1:200,000 epinephrine

Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) · Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which…

It is very uncertain whether 4% articaine plain changes speed of onset of anaesthesia (pulpal, electric pulp tester; healthy… compared with 4% articaine, 1:200,000 epinephrine (very low certainty).

1 finding from 1 review

4% prilocaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) · Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which…

4% prilocaine, 1:200,000 epinephrine showed no clear difference in success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:100,000 epinephrine (low certainty).

1 finding from 1 review

3% prilocaine, 0.03 IU felypressin vs 2% lidocaine, 1:100,000 epinephrine

Success of local anaesthesia, absence of pain (clinical testing of healthy pulps, hard and soft tissues) · Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which…

3% prilocaine, 0.03 IU felypressin probably leads to lower success of local anaesthesia, absence of pain (clinical testing of… compared with 2% lidocaine, 1:100,000 epinephrine (moderate certainty).

1 finding from 1 review

4% articaine, 1:200,000 epinephrine vs 4% articaine, 1:100,000 epinephrine

Success of local anaesthesia, absence of pain (clinical testing of healthy pulps, hard and soft tissues) · Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which…

It is very uncertain whether 4% articaine, 1:200,000 epinephrine changes success of local anaesthesia, absence of pain (clinical testing of… compared with 4% articaine, 1:100,000 epinephrine (very low certainty).

1 finding from 1 review

4% articaine, 1:200,000 epinephrine vs 4% articaine, 1:100,000 epinephrine

Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) · Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which…

It is very uncertain whether 4% articaine, 1:200,000 epinephrine changes speed of onset of anaesthesia (pulpal, electric pulp tester; healthy… compared with 4% articaine, 1:100,000 epinephrine (very low certainty).

1 finding from 1 review

Laser (Er:YAG, Er,Cr:YSGG, or Nd:YAG) vs Conventional mechanical caries removal (standard drill; handpiece with a bur)

Pulpal inflammation or necrosis · Children, adolescents and adults with caries in deciduous and permanent teeth (age 3.5 to 84 years)

It is very uncertain whether laser (Er:YAG, Er,Cr:YSGG, or Nd:YAG) changes pulpal inflammation or necrosis compared with conventional mechanical caries removal (standard drill; handpiece… (very low certainty).

3 findings from 1 review

Repair of a defective resin composite restoration in a permanent molar or premolar tooth (with resin composite) vs Replacement of a defective resin composite restoration in a permanent molar or premolar tooth (with resin composite)

Presence of clinical symptoms (pain, swelling, diagnosis of pulpitis, abscess formation) · Adults (16 years or over) with one or more defective resin composite restoration(s) in a molar or premolar tooth/teeth

The review found no eligible studies for this question.

1 finding from 1 review

Repair of a defective amalgam restoration in a permanent molar or premolar tooth (with amalgam) vs Replacement of a defective amalgam restoration in a permanent molar or premolar tooth (with amalgam)

Presence of clinical symptoms (pain, swelling, diagnosis of pulpitis, abscess formation) · Adults (16 years or over) with one or more defective amalgam restoration(s) in a molar or premolar tooth/teeth

The review found no eligible studies for this question.

1 finding from 1 review

Partial caries removal (single stage; residual dentinal caries sealed into the tooth definitively) vs Complete caries removal

Pulp exposure during caries removal · Patients with carious teeth, affecting any tooth surface(s), in unrestored primary and permanent teeth

Partial caries removal (single stage; residual dentinal caries… probably leads to lower pulp exposure during caries removal compared with complete caries removal (moderate certainty).

1 finding from 1 review

Stepwise excavation (two-stage caries removal, re-entry after an interval) vs Complete caries removal

Pulp exposure during caries removal · Patients with carious teeth, affecting any tooth surface(s), in unrestored primary and permanent teeth

Stepwise excavation (two-stage caries removal, re-entry after an… probably leads to lower pulp exposure during caries removal compared with one stage complete caries removal (moderate certainty).

3 findings from 1 review

Stepwise excavation (two-stage caries removal, re-entry after an interval) vs Complete caries removal

Signs or symptoms of pulpal disease · Patients with carious teeth, affecting any tooth surface(s), in unrestored primary and permanent teeth

Stepwise excavation (two-stage caries removal, re-entry after an… showed no clear difference in signs or symptoms of pulpal disease compared with one stage complete caries removal (moderate certainty).

1 finding from 1 review

Partial caries removal (single stage; residual dentinal caries sealed into the tooth definitively) vs Complete caries removal

Signs or symptoms of pulpal disease · Patients with carious teeth, affecting any tooth surface(s), in unrestored primary and permanent teeth

Partial caries removal (single stage; residual dentinal caries… showed no clear difference in signs or symptoms of pulpal disease compared with complete caries removal (low certainty).

1 finding from 1 review

Resin composite restorations containing antibacterial agents vs Non-antibacterial containing composite restorations

Postoperative sensitivity, marginal adaptation, anatomic form and other clinical outcomes (USPHS restoration quality; includes tooth vitality and pulpitis) · Adults and adolescents in any age group with restorations in the permanent dentition and children with restorations in the primary dentition

The review found no eligible studies for this question.

1 finding from 1 review

No dentinal caries removal (caries sealed under a preformed metal crown or restoration without removing dentinal caries) vs Complete caries removal

Signs or symptoms of pulpal disease · Patients with carious teeth, affecting any tooth surface(s), in unrestored primary and permanent teeth

No dentinal caries removal (caries sealed under a preformed metal… showed no clear difference in signs or symptoms of pulpal disease compared with complete caries removal (moderate certainty).

1 finding from 1 review

Hypnosis vs No hypnosis (no hypnotic intervention)

Physiological measures during local anaesthesia (pulse rate and oxygen saturation) · Children aged 4 to 13 years with no previous dental experience undergoing restorative treatment with local anaesthesia (Gokli 1994)
1 finding from 1 review
  • With regard to oxygen saturation and pulse rate, only pulse rate was significantly lower in the hypnosis group (P = 0.005); oxygen saturation did not differ significantly. (Gokli 1994; cross-over, 29 children.)
    1 study · 29 participants
    GRADE not reported

Mineral trioxide aggregate (MTA) vs Calcium hydroxide (CH)

Overall success (composite of clinical and radiographic success) · Permanent teeth with carious pulp exposure

In partial pulpotomy, MTA had significantly higher success than calcium hydroxide (OR 2.81; ungraded).

5 findings from 2 reviews · compare the 2 reviews
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Mineral trioxide aggregate (MTA) vs Calcium hydroxide (CH)

Postoperative pain (patient-reported) · Vital permanent teeth (mature or immature) with deep or extremely deep caries and asymptomatic pulp or reversible pulpitis, undergoing…

The effect of material choice (MTA vs CaOH) on postoperative pain is unclear: two small studies used different methods and reported contradictory results, so no meta-analysis was performed (ungraded).

1 finding from 1 review