Non-Cochrane · intervention · PM31249668
Pulpotomy versus pulpectomy in the treatment of vital pulp exposure in primary incisors. A systematic review and meta-analysis.
Gadallah Lamia, Hamdy Mahmoud, El Bardissy Adel, et al. · F1000Research · 2018 · PubMed · doi:10.12688/f1000research.16142.3
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
11
current version
GRADE rated
0
No studies
0
Included studies
4
linked below
No studies 0 · 0%Ungraded 11 · 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 | Children with carious vital pulp exposure in primary incisors | Children aged 18-60 months with carious vital pulp exposure in primary incisors (4 RCTs; 3 meta-analyzed, 338 teeth) |
| Intervention | Pulpotomy (techniques with different medicaments) | Pulpotomy (formocresol; ferric sulfate; or ferric sulfate + mineral trioxide aggregate) |
| Comparison | Pulpectomy / root canal treatment (techniques with different medicaments) | Pulpectomy (zinc oxide eugenol; or vitapex / calcium hydroxide-iodoform paste) |
| Outcomes | Primary: clinical failure; radiological failure. Secondary clinical: pain, soft tissue pathology, pathological mobility, tooth survival. Secondary radiographic: pathological radiolucency, pathological root resorption, pulp canal obliteration | Clinical failure RR 2.69 (0.76-9.58); radiographic failure RR 0.79 (0.25-2.42), sensitivity RR 0.45 (0.25-0.83); pain RR 2.06 (0.31-13.8); soft tissue pathology RR 3.11 (0.54-17.7); pathological root resorption RR 1.5 (0.56-4.04); periapical radiolucency, mobility, tooth survival, pulp canal obliteration reported narratively (not pooled) |
| Study designs | Randomized controlled trials | 4 RCTs (Nguyen 2017, Howley 2012, Aminabadi 2008, Casas 2004); 3 in meta-analysis (Casas excluded for high risk of bias) |
| Timing | Not specified | Longest follow-up 15-24 months |
Search date: March 2018 (databases searched to 1 March 2018). Databases: PubMed; Cochrane Library; OpenGrey (grey literature); ClinicalTrials.gov (ongoing trials); hand-searching of reference lists
Questions and results
Pulpotomy vs Pulpectomy
Population: Children with carious vital pulp exposure in primary incisors
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pathological mobility Longest follow-up Pathological mobility was rare (one tooth in one of four trials) and was not pooled. Source: Results (Pathological mobility) · same question in other reviews | Pathologic mobility was not reported for any tooth in three trials (Howley, Aminabadi, Casas); only one tooth with pathological mobility was reported by Nguyen et al. Not pooled. | 4 studies | Ungraded |
Soft tissue pathology Longest follow-up No statistically significant difference in soft tissue pathology between pulpotomy and pulpectomy (RR 3.11, 95% CI 0.54 to 17.7; ungraded). Source: Results (Synthesis of results; Soft tissue pathology) · same question in other reviews | RR 3.11 [0.54, 17.7] | NR | Ungraded |
Clinical failure Longest follow-up: 18 to 24 months; 15 to 23 months in Howley et al. · Overall Pulpotomy may not differ from pulpectomy for clinical failure; no GRADE rating was reported. Source: Figure 3; Results: Synthesis of results · same question in other reviews | RR 2.63 [0.76, 9.58] | 2 studies · 264 participants | Ungraded |
Pathological root resorption Longest follow-up No statistically significant difference in pathological root resorption between pulpotomy and pulpectomy (RR 1.5, 95% CI 0.56 to 4.04; ungraded). Source: Results (Synthesis of results; Pathological root resorption) · same question in other reviews | RR 1.5 [0.56, 4.04] | 2 studies | Ungraded |
Tooth survival 18-24 months Tooth survival was reported narratively in two trials and was not pooled. Source: Results (Tooth survival) · same question in other reviews | Survival rate 0.94 (95% CI 0.89 to 0.97) for pulpotomy and 0.97 for pulpectomy at 18 months (Nguyen et al.); 63% for pulpotomy and 85% for pulpectomy at 2 years (Casas et al.). Not pooled. | 2 studies | Ungraded |
Pathological periapical radiolucency Longest follow-up Two trials reported periapical radiolucency but results were not pooled owing to considerable heterogeneity. Source: Results (Synthesis of results; Pathological radiolucency) · same question in other reviews | The results of two trials showed considerable statistical heterogeneity so no meta-analysis was performed for this outcome. | 2 studies | Ungraded |
Radiographic failure Longest follow-up (15-24 months) No statistically significant difference in radiographic failure between pulpotomy and pulpectomy in the main analysis (RR 0.79, 95% CI 0.25 to 2.42), with considerable heterogeneity (I2=76%; ungraded). Source: Figure 4; Results (Synthesis of results); Discussion · same question in other reviews | RR 0.79 [0.25, 2.42] | 3 studies · 338 participants | Ungraded |
Pain Longest follow-up No statistically significant difference in pain between pulpotomy and pulpectomy (RR 2.06, 95% CI 0.31 to 13.8; ungraded). Source: Results (Synthesis of results; Pain) · same question in other reviews | RR 2.06 [0.31, 13.8] | NR | Ungraded |
Pulp canal obliteration 23-24 months Pulp canal obliteration was reported narratively (mainly in the pulpotomy group) and was not pooled. Source: Results (Pulp canal obliteration) · same question in other reviews | Pulp canal obliteration seen in 18 teeth (60%) in the pulpotomy group at 23 months (Howley et al.); none at 2 years (Aminabadi et al.); 3 teeth (25%) in the pulpotomy group at 2 years (Casas et al.). Not pooled. | 3 studies | Ungraded |
Radiographic failure Longest follow-up (18-23 months) · Sensitivity analysis excluding Aminabadi et al. (outlier) Excluding one outlying trial, pulpectomy had a significantly higher risk of radiographic failure than pulpotomy (RR 0.45, 95% CI 0.25 to 0.83; ungraded). Source: Table 8; Results (Synthesis of results); Abstract · same question in other reviews | RR 0.45 [0.25, 0.83] | 2 studies · 246 participants | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall failure | no estimate extracted | 2 studies | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Yes | Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: Yes | RCT: Yes · NRSI: N/A | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | No | no |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 4
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Aminabadi 2008 A clinical study of formocresol pulpotomy versus root canal therapy of vital primary incisors. PMID:18524271 | this review only | not stated | not extracted yet | not extracted yet |
| Casas 2004 Outcomes of vital primary incisor ferric sulfate pulpotomy and root canal therapy. PMID:14709254 | this review only | not stated | not extracted yet | not extracted yet |
| Howley 2012 Pulpotomy versus pulpectomy for carious vital primary incisors: randomized controlled trial. PMID:23211895 | this review only | not stated | not extracted yet | not extracted yet |
| Nguyen 2017 Comparison of Ferric Sulfate Combined Mineral Trioxide Aggregate Pulpotomy and Zinc Oxide Eugenol Pulpectomy of Primary Maxillary… PMID:28292339 | this review only | not stated | not extracted yet | not extracted yet |