Non-Cochrane · intervention · PM31647004
Materials for pulpotomy in immature permanent teeth: a systematic review and meta-analysis.
Chen Yuan, Chen Xinlei, Zhang Yali, et al. · BMC oral health · 2019 · PubMed · doi:10.1186/s12903-019-0917-z
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
5
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 | Immature (young) permanent teeth with open apex and vital pulp exposed to dental caries or trauma (in humans) | Immature permanent teeth with carious or traumatic pulp exposure in children aged 6-14 years (5 RCTs; 232 teeth and 118 roots) |
| Intervention | Pulpotomy dressing agents (e.g., MTA, calcium hydroxide, CEM, PRF, triple antibiotic paste) | MTA (index agent in all 5 trials); comparators CH, CEM, PRF, TAP and abscess remedy |
| Comparison | A different pulpotomy dressing agent (RCTs comparing two or more medicaments) | MTA vs CH (2 trials); MTA vs CEM, MTA vs PRF, and MTA vs TAP vs abscess remedy (1 trial each) |
| Outcomes | Clinical and/or radiographic success rate | Clinical and radiographic success rate |
| Study designs | Randomized controlled trials (RCTs) | 5 RCTs (4 parallel, 1 split-mouth); all judged high risk of bias |
| Timing | At least 6 months follow-up | 6 to 24 months follow-up |
Search date: Inception to October 2018. Databases: MEDLINE (via PubMed); EMBASE; Cochrane Library (CENTRAL); clinicaltrials.gov
Questions and results
Mineral trioxide aggregate (MTA) pulpotomy dressing vs Calcium hydroxide (CH)
Population: Immature (young) permanent teeth with open apex and vital pulp exposed to dental caries or trauma, in children aged 6-14 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success 12 months MTA and calcium hydroxide had similar clinical and radiographic pulpotomy success at 12 months (RR 1.04, 95% CI 0.96 to 1.13; 2 RCTs; ungraded). Source: Results 'Comparison 1: MTA versus CH', '12-month outcome'; Fig. 4 (forest plot) · same question in other reviews | RR 1.04 [0.96, 1.13] | 2 studies · 109 participants | Ungraded |
Clinical and radiographic success 6 months MTA and calcium hydroxide had similar clinical and radiographic pulpotomy success at 6 months (RR 1.00, 95% CI 0.94 to 1.06; 2 RCTs; ungraded). Source: Results 'Comparison 1: MTA versus CH', '6-month outcome'; Fig. 3 (forest plot) · same question in other reviews | RR 1.00 [0.94, 1.06] | 2 studies · 109 participants | Ungraded |
Mineral trioxide aggregate (MTA) pulpotomy dressing vs Calcium-enriched mixture (CEM) cement
Population: Immature (young) permanent teeth with open apex and vital pulp exposed to dental caries or trauma, in children aged 6-14 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success 6 and 12 months A single RCT found no difference in pulpotomy success between MTA and calcium-enriched mixture (both 100% at 6 and 12 months; not pooled; ungraded). Source: Results 'Comparison 2: MTA versus CEM'; Table 1 · same question in other reviews | Single RCT (Nosrat 2012, 118 roots): 100% clinical and radiographic success in both MTA and CEM at 6 and 12 months (MTA 53/53 then 54/54 roots; CEM 55/55 then 57/57 roots); no statistical difference between groups at… | 1 study · 118 participants | Ungraded |
Mineral trioxide aggregate (MTA) pulpotomy dressing vs Platelet-rich fibrin (PRF)
Population: Immature (young) permanent teeth with open apex and vital pulp exposed to dental caries or trauma, in children aged 6-14 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success 6, 12 and 24 months A single RCT found no difference in pulpotomy success between MTA and platelet-rich fibrin (both 100% through 24 months; not pooled; ungraded). Source: Results 'Comparison 3: MTA versus PRF'; Table 1 · same question in other reviews | Single RCT (Keswani 2014, 62 teeth): 100% clinical and radiographic success in both MTA and PRF at 6, 12 and 24 months (MTA 29/29, 27/27, 26/26; PRF 30/30, 29/29, 27/27); no difference between groups; not pooled | 1 study · 62 participants | Ungraded |
Mineral trioxide aggregate (MTA) pulpotomy dressing vs Triple antibiotic paste (TAP)
Population: Immature (young) permanent teeth with open apex and vital pulp exposed to dental caries or trauma, in children aged 6-14 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success 1 to 24 months A single 3-arm RCT found no difference in pulpotomy success between MTA and triple antibiotic paste (both 100%; not pooled; ungraded). Source: Results 'Comparison 4: MTA versus TAP versus abscess remedy'; Table 1 · same question in other reviews | Single RCT (Eppa 2018, 3-arm; 20 MTA and 20 TAP teeth): 100% clinical and radiographic success in both MTA and TAP at all follow-ups (1-24 months); no difference between groups; not pooled | 1 study · 40 participants | Ungraded |
Mineral trioxide aggregate (MTA) pulpotomy dressing vs Abscess remedy (AR)
Population: Immature (young) permanent teeth with open apex and vital pulp exposed to dental caries or trauma, in children aged 6-14 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success 3 to 24 months A single RCT found higher pulpotomy success with MTA than abscess remedy (100% vs 80%; statistically significant, P<0.05; not pooled; ungraded). Source: Results 'Comparison 4: MTA versus TAP versus abscess remedy'; Table 1 · same question in other reviews | Single RCT (Eppa 2018, 3-arm; 20 MTA and 20 AR teeth): MTA 100% (20/20) vs abscess remedy 80% (16/20) clinical and radiographic success; the 4 abscess-remedy failures occurred at 3 months; difference statistically… | 1 study · 40 participants | Ungraded |
Triple antibiotic paste (TAP) vs Abscess remedy (AR)
Population: Immature (young) permanent teeth with open apex and vital pulp exposed to dental caries or trauma, in children aged 6-14 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success 3 to 24 months 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). Source: Results 'Comparison 4: MTA versus TAP versus abscess remedy'; abstract; Table 1 · same question in other reviews | Single RCT (Eppa 2018, 3-arm; 20 TAP and 20 AR teeth): TAP 100% (20/20) vs abscess remedy 80% (16/20) clinical and radiographic success; difference statistically significant at 3, 6, 9, 12, 18 and 24 months (P<0.05);… | 1 study · 40 participants | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and radiographic success MTA vs CH, 3 months (El-Meligy 2006) | no estimate extracted | 1 study | Ungraded |
Calcific metamorphosis (adverse event) MTA vs CH (El-Meligy 2006) | no estimate extracted | 1 study | Ungraded |
Marginal restoration discoloration (adverse event) MTA vs CH (Ozgur 2017) | no estimate extracted | 1 study | Ungraded |
Clinical and radiographic success MTA vs CH, 18 and 24 months (Ozgur 2017) | no estimate extracted | 1 study | 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 | Yes | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial 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 | RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: Yes | RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | No | no |
| 15Publication bias investigatedcritical | No | N/A | no |
| 16Conflicts of interest reported | Yes | No | no |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 5
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Eppa 2018 Comparative Evaluation of Three Different Materials: Mineral Trioxide Aggregate, Triple Antibiotic Paste, and Abscess Remedy on Apical… PMID:29875553 | 1 other review | not stated | not extracted yet | not extracted yet |
| Keswani 2014 Comparative evaluation of platelet-rich fibrin and mineral trioxide aggregate as pulpotomy agents in permanent teeth with incomplete root… PMID:24767550 | 1 other review | Clinical and radiographic success | not extracted yet | not extracted yet |
| Nosrat 2012 Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized… PMID:22309243 | 1 other review | Clinical and radiographic success | not extracted yet | not extracted yet |
| Ozgur 2017 Partial Pulpotomy in Immature Permanent Molars After Carious Exposures Using Different Hemorrhage Control and Capping Materials. PMID:29070158 | 1 other review | Clinical and radiographic success | not extracted yet | not extracted yet |
| El-Meligy 2006 Comparison of mineral trioxide aggregate and calcium hydroxide as pulpotomy agents in young permanent teeth (apexogenesis). PMID:17036703 | this review only | Clinical and radiographic success | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).
| Review | Shared studies | Jaccard |
|---|---|---|
| Efficacy of pulpotomy for permanent teeth with carious pulp exposure: A systematic review and meta-analysis of randomized controlled trials. (2024) | 4 | 0.15 |