Cochrane · intervention · CD004484

Pulp management for caries in adults: maintaining pulp vitality

Cochrane Database of Systematic Reviews · 2007 · Cochrane Library

Oral Health Dental caries Endodontics and dental trauma2 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

15

current version

GRADE rated

0

No studies

0

Included studies

4

as reported

No studies 0 · 0%Ungraded 15 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Patients with permanent teeth with extensive caries which were asymptomatic; traumatised teeth excluded	Adults with asymptomatic vital permanent teeth with extensive caries (Shovelton 1971: 275 patients with asymptomatic vital exposures; Fitzgerald 1991: 55 patients/151 teeth, aged 20-60, mean 27; Hodosh 2003: 47 adults with pulpal exposures; Whitworth 2005: 602 healthy adults, asymptomatic posterior teeth with vital pulp)
Intervention	Techniques used to maintain pulp vitality (indirect pulp capping; stepwise technique; direct pulp capping; pulpotomy)	Ledermix (n=275); Glycerrhetinic acid/antibiotic mixture (n=275); Calcium hydroxide (n=275); Life (n=151); Dycal (n=151); Cavitec (n=151); KNO3/DMI/PCa cement (n=18); KNO3/PCa (n=17); Conditioning and sealing with adhesive resin (n=602)
Comparison	Another technique used to maintain pulp vitality (head-to-head)	Zinc oxide eugenol (n=275); Cavitec (n=151); PCa alone (n=12); Conventional calcium hydroxide lining (n=602)
Outcomes	Clinical success (binary); Extraction (binary); Patient satisfaction (binary or continuous); Adverse events (pain, swelling, tooth fracture, instrument fracture, perforation of root)	Clinical success or clinical symptoms (n=4); Pulpal breakdown/loss of vitality (n=1); Post-operative pain on VAS (n=1); Extraction (n=1)
Study designs	Randomised controlled trials (RCTs) or quasi-randomised controlled trials	Randomised controlled trials (n=4; one 8-centre, one double-blind, one single-blind, one tooth-level analysis)
Timing	Not specified	6 to 36 months (Shovelton 6/12/24 months; Fitzgerald 1 week/6 months/1 year; Hodosh 3 months/1/2 years; Whitworth 6/12/24/36 months)

Search date: 2006-03. Databases: The Cochrane Oral Health Group's Trials Register (March 2006); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 1); MEDLINE (1966 to week 4 February 2006); EMBASE (1974 to 13 March 2006); National Research Register (March 2006); Science Citation Index…

Questions and results

Show all 2 versions

Ledermix (corticosteroid/antibiotic pulp-capping cement) vs Glycerrhetinic acid/antibiotic mixture

Population: Adults with asymptomatic teeth with vital carious pulp exposures

1 question

Outcome	Effect	Evidence	Status / GRADE
Clinical success (survival free of symptoms) at 24 months 24 months same question in other reviews	Shovelton 1971 (Analysis 1.1): 275 teeth followed for 2 years (235 at 6 months, 160 at 12 months, 85 analysed at 24 months). Success rates 50% to 80%. Ledermix and calcium hydroxide had the highest success rates,…	1 study · 275 participants	Ungraded

Ledermix (corticosteroid/antibiotic pulp-capping cement) vs Calcium hydroxide

Population: Adults with asymptomatic teeth with vital carious pulp exposures

1 question

Outcome	Effect	Evidence	Status / GRADE
Clinical success (survival free of symptoms) at 24 months 24 months same question in other reviews	Shovelton 1971 (Analysis 1.1): 275 teeth followed for 2 years (235 at 6 months, 160 at 12 months, 85 analysed at 24 months). Success rates 50% to 80%. Ledermix and calcium hydroxide had the highest success rates,…	1 study · 275 participants	Ungraded

Ledermix (corticosteroid/antibiotic pulp-capping cement) vs Zinc oxide eugenol

Population: Adults with asymptomatic teeth with vital carious pulp exposures

1 question

Outcome	Effect	Evidence	Status / GRADE
Clinical success (survival free of symptoms) at 24 months 24 months same question in other reviews	Shovelton 1971 (Analysis 1.1): 275 teeth followed for 2 years (235 at 6 months, 160 at 12 months, 85 analysed at 24 months). Success rates 50% to 80%. Ledermix and calcium hydroxide had the highest success rates,…	1 study · 275 participants	Ungraded

Glycerrhetinic acid/antibiotic mixture vs Calcium hydroxide

Population: Adults with asymptomatic teeth with vital carious pulp exposures

1 question

Outcome	Effect	Evidence	Status / GRADE
Clinical success (survival free of symptoms) at 24 months 24 months same question in other reviews	Shovelton 1971 (Analysis 1.1): 275 teeth followed for 2 years (235 at 6 months, 160 at 12 months, 85 analysed at 24 months). Success rates 50% to 80%. Ledermix and calcium hydroxide had the highest success rates,…	1 study · 275 participants	Ungraded

Glycerrhetinic acid/antibiotic mixture vs Zinc oxide eugenol

Population: Adults with asymptomatic teeth with vital carious pulp exposures

1 question

Outcome	Effect	Evidence	Status / GRADE
Clinical success (survival free of symptoms) at 24 months 24 months same question in other reviews	Shovelton 1971 (Analysis 1.1): 275 teeth followed for 2 years (235 at 6 months, 160 at 12 months, 85 analysed at 24 months). Success rates 50% to 80%. Ledermix and calcium hydroxide had the highest success rates,…	1 study · 275 participants	Ungraded

Calcium hydroxide vs Zinc oxide eugenol

Population: Adults with asymptomatic teeth with vital carious pulp exposures

1 question

Outcome	Effect	Evidence	Status / GRADE
Clinical success (survival free of symptoms) at 24 months 24 months same question in other reviews	Shovelton 1971 (Analysis 1.1): 275 teeth followed for 2 years (235 at 6 months, 160 at 12 months, 85 analysed at 24 months). Success rates 50% to 80%. Ledermix and calcium hydroxide had the highest success rates,…	1 study · 275 participants	Ungraded

Life (calcium hydroxide pulp-capping material) vs Dycal (calcium hydroxide pulp-capping material)

Population: Adults (aged 20 to 60 years, mean 27) with deep carious lesions in permanent teeth (indirect or direct pulp capping, or complete caries removal)

3 questions

Outcome	Effect	Evidence	Status / GRADE
Clinical symptoms at 12 months 12 months · Complete caries removal same question in other reviews	Analysis 2.2 (clinical symptoms at 12 months following complete caries removal, Life vs Dycal). Fitzgerald 1991: 151 teeth in 55 patients (analysis at tooth level, not patient level); substantial attrition (11 teeth…	1 study · 151 participants	Ungraded
Clinical symptoms at 12 months 12 months · Indirect pulp capping same question in other reviews	Analysis 2.1 (clinical symptoms at 12 months following indirect pulp capping, Life vs Dycal). Fitzgerald 1991: 151 teeth in 55 patients (analysis at tooth level, not patient level); substantial attrition (11 teeth lost…	1 study · 151 participants	Ungraded
Clinical symptoms at 12 months 12 months · Direct pulp capping same question in other reviews	Analysis 2.3 (clinical symptoms at 12 months following direct pulp capping, Life vs Dycal). Fitzgerald 1991: 151 teeth in 55 patients (analysis at tooth level, not patient level); substantial attrition (11 teeth lost…	1 study · 151 participants	Ungraded

Life (calcium hydroxide material) vs Cavitec (zinc oxide eugenol material)

Population: Adults (aged 20 to 60 years, mean 27) with deep carious lesions in permanent teeth (indirect or direct pulp capping, or complete caries removal)

1 question

Outcome	Effect	Evidence	Status / GRADE
Clinical symptoms at 12 months 12 months · Complete caries removal same question in other reviews	Analysis 2.2 (clinical symptoms at 12 months following complete caries removal, Life vs Cavitec). Fitzgerald 1991: 151 teeth in 55 patients (analysis at tooth level, not patient level); substantial attrition (11 teeth…	1 study · 151 participants	Ungraded

Dycal (calcium hydroxide material) vs Cavitec (zinc oxide eugenol material)

Population: Adults (aged 20 to 60 years, mean 27) with deep carious lesions in permanent teeth (indirect or direct pulp capping, or complete caries removal)

1 question

Outcome	Effect	Evidence	Status / GRADE
Clinical symptoms at 12 months 12 months · Complete caries removal same question in other reviews	Analysis 2.2 (clinical symptoms at 12 months following complete caries removal, Dycal vs Cavitec). Fitzgerald 1991: 151 teeth in 55 patients (analysis at tooth level, not patient level); substantial attrition (11 teeth…	1 study · 151 participants	Ungraded

Potassium nitrate/dimethyl isosorbide/polycarboxylate cement (KNO3/DMI/PCa) vs Potassium nitrate/polycarboxylate cement (KNO3/PCa)

Population: Adults with asymptomatic vital pulpal exposures from caries

1 question

Outcome	Effect	Evidence	Status / GRADE
Clinical success (absence of periapical pathology, tenderness to pressure and fistula formation) at 24 months 24 months same question in other reviews	Hodosh 2003 (Analysis 3.1): all 18 patients receiving KNO3/DMI/PCa responded favourably (0/18 developed clinical symptoms) versus 9/17 in the KNO3/PCa group; symptomatic teeth required endodontic therapy or extraction.…	1 study · 35 participants	Ungraded

Potassium nitrate/polycarboxylate cement (KNO3/PCa) vs Polycarboxylate cement (PCa) alone

Population: Adults with asymptomatic vital pulpal exposures from caries

1 question

Outcome	Effect	Evidence	Status / GRADE
Clinical success (absence of periapical pathology, tenderness to pressure and fistula formation) at 24 months 24 months same question in other reviews	Hodosh 2003 (Analysis 3.1): 9/17 in the KNO3/PCa group and 10/12 in the PCa group developed clinical symptoms requiring endodontic therapy or extraction. No significance test reported for this specific contrast; no…	1 study · 29 participants	Ungraded

Potassium nitrate/dimethyl isosorbide/polycarboxylate cement (KNO3/DMI/PCa) vs Polycarboxylate cement (PCa) alone

Population: Adults with asymptomatic vital pulpal exposures from caries

1 question

Outcome	Effect	Evidence	Status / GRADE
Clinical success (absence of periapical pathology, tenderness to pressure and fistula formation) at 24 months 24 months same question in other reviews	Hodosh 2003 (Analysis 3.1): all 18 patients receiving KNO3/DMI/PCa responded favourably (0/18 developed clinical symptoms) versus 10/12 in the PCa group. "The results in groups two and three were statistically…	1 study · 30 participants	Ungraded

Conditioning and sealing with an adhesive resin (smear-removing bonding system) vs Conventional calcium hydroxide lining

Population: Healthy adults with asymptomatic posterior permanent teeth with deep caries and a vital (non-exposed) pulp requiring restoration

1 question

Outcome	Effect	Evidence	Status / GRADE
Maintenance of pulp vitality (freedom from pulpal breakdown) up to 36 months 36 months same question in other reviews	Whitworth 2005: 602 teeth randomised; 39 emergency recalls over the 36 months after restoration, with pulp breakdown associated with 16 teeth. The authors concluded that "dentists should be confident that pulps will be…	1 study · 602 participants	Ungraded