Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

480 questions · 559 findings · 16 reviews · Endodontics and dental trauma

No studies found 75 · 13.4%GRADE not reported 394 · 70.5%Very low 39 · 7%Low 36 · 6.4%Moderate 14 · 2.5%High 1 · 0.2%

Bulk-fill composite resin with 7-second dentine etching vs Bulk-fill composite resin with 15-second dentine etching

Treatment failure (annual failure rate) · Children (aged 5-8 years) with Class-II caries in primary molars, no pulp therapy

Etching dentine for 7 s rather than 15 s lowered bulk-fill composite failure (5.8% vs 16.9% annual failure) in one RCT; low quality of evidence (ungraded).

1 finding from 1 review

Metal-free single crowns (full-contour zirconia) vs Composite strip crown

Treatment failure (annual failure rate) · Children (aged 3-5.5 years) with early childhood caries in anterior primary teeth (>=2 carious surfaces), no pulp therapy

Zirconia crowns failed less than composite strip crowns (3.3% vs 15% annual failure) in one RCT; low quality of evidence (ungraded).

1 finding from 1 review

Bio-active restorative materials vs Any conventional restorative material

Treatment failure (planned; no eligible studies) · Children with carious primary teeth after vital or non-vital pulp therapy

No eligible studies were found evaluating bio-active restorative materials for restoring carious primary teeth after pulp therapy.

1 finding from 1 review

Metal-reinforced glass-ionomer cement (MRGIC) restoration vs Conventional GIC

Treatment failure (annual failure rate) · Children with previously unrestored, vital carious lesions in primary teeth (no pulp therapy); aged 1.5-11 years

Metal-reinforced GIC had a high annual failure rate (29.9%) in a single RCT; low quality of evidence (ungraded).

1 finding from 1 review

Compomer (C) vs Amalgam, RMGIC, HVGIC, composite resin, bulk-fill composite resin, another compomer, or alternative caries management

Treatment failure (annual failure rate) · Children with previously unrestored, vital carious lesions in primary teeth (no pulp therapy); aged 1.5-11 years

Compomer had an annual failure rate of 0-14.7% (7 RCTs), comparable to amalgam/RMGIC/composite and better than high-viscosity GIC; low quality of evidence (ungraded).

1 finding from 1 review

Conventional GIC vs Amalgam or metal-reinforced GIC

Treatment failure (annual failure rate) · Children with previously unrestored, vital carious lesions in primary teeth (no pulp therapy); aged 1.5-11 years

Conventional GIC had an annual failure rate of 7.6-16.6% (2 RCTs) and failed more than amalgam in one trial; low quality of evidence (ungraded).

1 finding from 1 review

Class-I (single-surface) cavity restoration vs Class-II (proximal/multi-surface) cavity restoration

Treatment failure (annual failure rate) by cavity class · Children with carious primary teeth restored in Class-I versus Class-II cavities, no pulp therapy

Class-II restorations failed more than Class-I (annual failure 5-28.9% vs 1.2-14.7% in ART studies); low quality of evidence (ungraded).

1 finding from 1 review

Hall technique vs Compomer restoration or non-restorative caries treatment

Treatment failure (annual failure rate) · Children (aged 3-8 years) with 2-surface occluso-proximal dentine caries in primary molars, no pulp therapy

Preformed metal (Hall) crowns had a low reported annual failure rate (3.1%) versus compomer (14.7%) in one RCT; low quality of evidence (ungraded).

1 finding from 1 review

Composite resin vs Compomer, glass-ionomer/RMGIC, amalgam, or glass carbomer

Treatment failure (annual failure rate) · Children with previously unrestored, vital carious lesions in primary teeth (no pulp therapy); aged 1.5-11 years

Composite resin (hybrid 0-19.5%; bulk-fill 0-16.9%) performed comparably to or better than most alternatives across 11 RCTs; evidence is of low to unclear quality (ungraded).

1 finding from 1 review

Bio-active restorative materials vs Any restorative material or technique

Not applicable (no eligible studies) · Children with carious primary teeth (no pulp therapy)

No eligible RCTs assessed new bio-active restorative materials in carious primary teeth; this is an evidence gap identified by the review.

1 finding from 1 review

Glass carbomer restoration (placed after drilling) vs Composite resin or RMGIC

Treatment failure (annual failure rate) · Children with previously unrestored, vital carious lesions in primary teeth (no pulp therapy); aged 1.5-11 years

Glass carbomer had very high failure rates (up to 46.2%) in a single RCT, far worse than composite resin or RMGIC; low quality of evidence (ungraded).

1 finding from 1 review

Amalgam vs Preformed metal crown (PMC)

Treatment failure (annual failure rate) · Children with carious primary molars treated by pulpotomy (vital pulp therapy)

Preformed metal crowns had a low annual failure rate (2.4%) in primary molars after pulpotomy, lower than amalgam in the same trial (single high-risk-of-bias RCT; low quality of evidence; not GRADE-rated).

2 findings from 1 review

Systemic antibiotic (oral penicillin 500 mg) plus analgesic vs Placebo plus analgesic

Total number of ibuprofen tablets · Adults over 18 years presenting with a single tooth with a clinical diagnosis of irreversible pulpitis

Systemic antibiotic (oral penicillin 500 mg) plus analgesic showed no clear difference in total number of ibuprofen tablets compared with placebo plus analgesic (low certainty).

1 finding from 1 review

Triple antibiotic paste (TAP) vs Abscess remedy (AR)

Overall success (composite of clinical and radiographic success) · Immature (young) permanent teeth with open apex and vital pulp exposed to dental caries or trauma, in children aged 6-14 years

A single RCT found higher pulpotomy success with triple antibiotic paste than abscess remedy (100% vs 80%; statistically significant, P<0.05; not pooled; ungraded).

1 finding from 1 review

Systemic antibiotic (oral penicillin 500 mg) plus analgesic vs Placebo plus analgesic

Patient-reported pain intensity (sum of pain intensity difference (SPID) and sum of pain percussion intensity difference (SPPID)) · Adults over 18 years presenting with a single tooth with a clinical diagnosis of irreversible pulpitis
1 finding from 1 review
  • Antibiotic use for irreversible pulpitis 2019 · Cochrane All outcomes
    7 days
    Corresponding risk (Antibiotics): The in between-group differences (median +/- IQR) in SPID for the penicillin group were 6.0 +/- 10.5, and for placebo 6.0 +/- 9.5. The SPPID for the penicillin group was 3.5 +/- 7.5…
    1 study · 40 participants
    Low

Systemic antibiotic (oral penicillin 500 mg) plus analgesic vs Placebo plus analgesic

Total number of paracetamol (acetaminophen) with codeine (Tylenol) tablets · Adults over 18 years presenting with a single tooth with a clinical diagnosis of irreversible pulpitis

Systemic antibiotic (oral penicillin 500 mg) plus analgesic showed no clear difference in total number of paracetamol (acetaminophen) with codeine (Tylenol)… compared with placebo plus analgesic (low certainty).

1 finding from 1 review

Glutaraldehyde + zinc oxide and eugenol (ZOE) vs Full strength formocresol (FC)

Clinical failure · Children with extensive decay involving the dental pulp in primary teeth

Glutaraldehyde + zinc oxide and eugenol (ZOE) showed no clear difference in clinical failure compared with full strength formocresol (FC); GRADE not reported.

1 finding from 1 review

Metapex (calcium hydroxide/iodoform) vs Endoflas chlorophenol free (Endoflas-CF)

Radiological failure · Children with extensive decay involving the dental pulp in primary teeth

Metapex (calcium hydroxide/iodoform) showed no clear difference in radiological failure compared with endoflas chlorophenol free (Endoflas-CF); GRADE not reported.

1 finding from 1 review