Non-Cochrane · intervention · PM42402583
Chitosan pulpotomy medicaments versus conventional agents in primary teeth: a systematic review and meta-analysis.
Kumari Prachi, Dhull Kanika Singh, Dutta Brahmananda, et al. · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-09147-z
Findings
7 findings
| Population | ||||
|---|---|---|---|---|
| Children aged 4-9 years with cariously exposed primary molars and vital radicular pulp requiring vital pulpotomy | Chitosan-based pulpotomy medicaments (chitosan solution, Axiostat sponge, chitosan with MTA) | Conventional pulpotomy medicaments (formocresol or ferric sulfate) | Clinical success (absence of pain, swelling, sinus tract, abnormal mobility) 6 months · Dental clinics in India | RR 1.00 [0.94, 1.06] 965 per 1000 vs 988 per 1000 Moderate Downgraded: imprecision, indirectness, publication bias 4 studies · 172 participants |
| Children aged 4-9 years with cariously exposed primary molars needing vital pulpotomy | Chitosan-based pulpotomy medicaments (chitosan solution, Axiostat sponge, chitosan + MTA) | Conventional agents (formocresol or ferric sulfate) | Clinical success (absence of pain, swelling, sinus tract, abnormal mobility) 6 months · Dental clinics, India · Sensitivity analysis excluding multi-arm RCT (Lahoti 2024) | RR 1.00 [0.93, 1.07] GRADE not reported 3 studies |
| Children aged 4-9 years with cariously exposed primary molars needing vital pulpotomy | Chitosan-based pulpotomy medicaments (chitosan solution, Axiostat sponge, chitosan + MTA) | Conventional agents (formocresol or ferric sulfate) | Radiographic success (absence of pathological root resorption, furcation radiolucency, periapical pathology) 6 months · Dental clinics, India · Sensitivity analysis excluding multi-arm RCT (Lahoti 2024) | RR 1.02 [0.91, 1.14] GRADE not reported 3 studies |
| Children aged 4-9 years with cariously exposed primary molars needing vital pulpotomy | Chitosan-based pulpotomy medicaments (chitosan solution, Axiostat sponge, chitosan + MTA) | Conventional agents (formocresol or ferric sulfate) | Radiographic success (absence of pathological root resorption, furcation radiolucency, periapical pathology) 6 months · Dental clinics, India · Figure value as printed in Fig. 3 forest plot Unresolved: the two extractors disagree on this row. | RR 1.01 [0.93, 1.10] Low 4 studies · 169 participants |
| Children aged 4-9 years with cariously exposed primary molars and vital radicular pulp requiring vital pulpotomy | Chitosan-based pulpotomy medicaments (chitosan solution, Axiostat sponge, chitosan with MTA) | Conventional pulpotomy medicaments (formocresol or ferric sulfate) | Radiographic success (absence of pathological root resorption, furcation radiolucency, periapical pathology) 6 months · Dental clinics in India | RR 1.04 [0.93, 1.16] 847 per 1000 vs 881 per 1000 Low Downgraded: imprecision, indirectness, publication bias 4 studies · 169 participants |
| Children aged 4-9 years with cariously exposed primary molars and vital radicular pulp requiring vital pulpotomy | Chitosan-based pulpotomy medicaments (chitosan solution, Axiostat sponge, chitosan with MTA) | Mineral trioxide aggregate | Clinical and radiographic success at 6-24 months Unresolved: the two extractors disagree on this row. | no estimate extracted No studies found 0 studies |
| Children aged 4-9 years with cariously exposed primary molars and vital radicular pulp requiring vital pulpotomy | Chitosan-based pulpotomy medicaments (chitosan solution, Axiostat sponge, chitosan with MTA) | Calcium hydroxide | Clinical and radiographic success at 6-24 months Unresolved: the two extractors disagree on this row. | no estimate extracted No studies found 0 studies |
Included primary studies 4
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Lahoti 2024 Comparative Evaluation of Amniotic Membrane Derivative, Chitosan with Mineral Trioxide Aggregate, Diode Laser, and Ferric Sulfate as… PMID:39184892 | 2024 | 1 other review | not stated | not extracted yet |
| Guguloth 2023 Evaluation of Chitosan and Ferric Sulphate as Pulpotomy Agents in Primary Teeth: A Randomized Controlled Trial. PMID:37519981 | 2023 | this review only | not stated | not extracted yet |
| Kothari 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Krishna 2025 Evaluation of Chitosan (Axiostat®) as a Pulpotomy Agent in Primary Molars: An In Vivo Study. PMID:41509966 | 2025 | this review only | not stated | 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). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Efficacy and safety of diode laser in pulpotomy: a systematic review and meta-analysis. (2026) | 1 | 0.06 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Primary molars in systemically healthy children aged 4-9 years with deep carious lesions, coronal pulp exposure and vital radicular pulp | Primary molars in children aged 4-9 years (n=196 teeth, 172 analyzed for clinical and 169 for radiographic success) |
| Intervention | Chitosan-based medicaments (e.g. chitosan gel, Axiostat) used as pulpotomy agents after coronal pulp amputation | Chitosan solution, Axiostat chitosan sponge, chitosan with MTA (n=4) |
| Comparison | Conventional pulpotomy medicaments: formocresol, MTA, ferric sulfate, calcium hydroxide | Formocresol (n=2), ferric sulfate (n=2) |
| Outcomes | Clinical success and radiographic success at 6-24 months | Clinical success (n=4); radiographic success (n=4) |
| Study designs | RCTs only | RCTs, parallel group, all from India (n=4) |
| Timing | Follow-up of at least 6 months (6-24 months) | 6 months (n=4) |
AMSTAR 2 items
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 | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | No | No | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Yes | 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 | 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 | Yes | yes |
| Overall | Critically Low | Critically Low | yes |