Lin Po-Yen, Chen Hsueh-Szu, Wang Yu-Hsiang, Tu Yu-Kang
Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.
Department of Dentistry, Taiwan Adventist Hospital, Taipei, Taiwan.
J Dent. 2014 Sep;42(9):1060-77. doi: 10.1016/j.jdent.2014.02.001. Epub 2014 Feb 7.
Pulpotomy is a common procedure to treat asymptomatic reversible pulpitis in primary molars. The aim of this study is to undertake a systematic review and a network meta-analysis to compare the clinical and radiographic outcomes of different pulpotomy procedures in primary molars.
Three authors performed data extraction independently and in duplicate using data collection forms. Disagreements were resolved by discussion.
An electronic literature search was performed within MEDLINE (via PubMed), ScienceDirect, Web of Science, Cochrane, and ClinicalKey databases until December 2012. Medications for pulpotomy including formocresol, ferric sulfate, calcium hydroxide, and mineral trioxide aggregate (MTA), and laser pulpotomy are compared using Bayesian network meta-analyses. The outcome is the odds ratio for clinical and radiographic failure including premature tooth loss at 12 and 24 months after treatments amongst different treatment procedures. 37 studies were included in the systematic review, and 22 of them in the final network meta-analyses. After 18-24 months, in terms of treatment failure, the odds ratio for calcium hydroxide vs. formocresol was 1.94 [95% credible interval (CI): 1.11, 3.25]; 3.38 (95% CI: 1.37, 8.61) for lasers vs. formocresol; 2.16 (95% CI: 1.12, 4.31) for calcium hydroxide vs. ferric sulfate; 3.73 (95% CI: 1.27, 11.67) for lasers vs. ferric sulfate; 0.47 (95% CI: 0.26, 0.83) for MTA vs. calcium hydroxide; 3.76 (95% CI: 1.39, 10.08) for lasers vs.
After 18-24 months, formocresol, ferric sulfate, and MTA showed significantly better clinical and radiographic outcomes than calcium hydroxide and laser therapies in primary molar pulpotomies.
The network meta-analyses showed that MTA is the first choice for primary molar pulpotomies. However, if treatment cost is an issue, especially when the treated primary molars are going to be replaced by permanent teeth, ferric sulfate may be the choice.
牙髓切断术是治疗乳磨牙无症状性可逆性牙髓炎的常见方法。本研究旨在进行系统评价和网状Meta分析，以比较不同牙髓切断术治疗乳磨牙的临床和影像学结果。
三位作者使用数据收集表独立且重复地进行数据提取。分歧通过讨论解决。
截至2012年12月，在MEDLINE（通过PubMed）、ScienceDirect、科学网、Cochrane和ClinicalKey数据库中进行了电子文献检索。使用贝叶斯网状Meta分析比较了牙髓切断术的药物，包括甲醛甲酚、硫酸铁、氢氧化钙和三氧化矿物凝聚体（MTA），以及激光牙髓切断术。结果是不同治疗方法在治疗后12个月和24个月时临床和影像学失败的比值比，包括过早牙齿脱落。系统评价纳入了37项研究，最终的网状Meta分析纳入了其中22项。18 - 24个月后，就治疗失败而言，氢氧化钙与甲醛甲酚的比值比为1.94[95%可信区间（CI）：1.11, 3.25]；激光与甲醛甲酚的比值比为3.38（95%CI：1.37, 8.61）；氢氧化钙与硫酸铁的比值比为2.16（95%CI：1.12, 4.31）；激光与硫酸铁的比值比为3.73（95%CI：1.27, 11.67）；MTA与氢氧化钙的比值比为0.47（95%CI：0.26, 0.83）；激光与MTA的比值比为3.76（95%CI：1.39, 10.08）。
18 - 24个月后，在乳磨牙牙髓切断术中，甲醛甲酚、硫酸铁和MTA在临床和影像学结果上显著优于氢氧化钙和激光治疗。
网状Meta分析表明，MTA是乳磨牙牙髓切断术的首选。然而，如果治疗成本是一个问题，特别是当治疗的乳磨牙将被恒牙替代时，硫酸铁可能是选择。
