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

current version

GRADE rated

No studies

Included studies

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

Current version only

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

Population: Adults with asymptomatic teeth with vital carious pulp exposures

CD004484.PUB2 (current) · 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

CD004484.PUB2 (current) · 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

CD004484.PUB2 (current) · 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

CD004484.PUB2 (current) · 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

CD004484.PUB2 (current) · 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

CD004484.PUB2 (current) · 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)

CD004484.PUB2 (current) · 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)

CD004484.PUB2 (current) · 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)

CD004484.PUB2 (current) · 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

CD004484.PUB2 (current) · 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

CD004484.PUB2 (current) · 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

CD004484.PUB2 (current) · 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

CD004484.PUB2 (current) · 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

Technique to maintain pulp vitality (indirect pulp capping, stepwise technique, direct pulp capping, or pulpotomy) vs Pulpectomy

Population: Adults with permanent teeth with extensive caries, asymptomatic (vital pulp)

CD004484 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	no estimate extracted	0 studies	No studies

Technique to maintain pulp vitality (indirect pulp capping, stepwise technique, direct pulp capping, or pulpotomy) vs Another technique to maintain pulp vitality (head-to-head)

Population: Adults with permanent teeth with extensive caries, asymptomatic (vital pulp)

CD004484 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	no estimate extracted	0 studies	No studies