Coll James A, Seale N Sue, Vargas Kaaren, Marghalani Abdullah A, Al Shamali Shahad, Graham Laurel
Clinical professor, Division of Pediatric Dentistry, at the University of Maryland Dental School, Baltimore, Md., USA.
Regents Professor, Department of Pediatric Dentistry, Texas A&M College of Dentistry, Dallas, Texas, USA;, Email:
Pediatr Dent. 2017 Jan 15;39(1):16-123.
This systematic review and meta-analysis assessed outcomes in primary teeth for the vital pulp therapy (VPT) options of indirect pulp therapy (IPT), direct pulp capping (DPC), and pulpotomy after a minimum of 12 months to determine whether one VPT was superior.
The following databases were searched from 1960 to September 2016: MEDLINE, EMBASE, CENTRAL, EBSCO, ICTRP, Dissertation abstracts, and grey literature for parallel and split-mouth randomized controlled trials of at least 12 months duration comparing the success of IPT, DPC, and pulpotomy in children with deep caries in primary teeth. Our primary outcome measure was overall success (combined clinical and radiographic). Three authors determined the included RCTs, performed data extraction, and assessed the risk of bias (ROB). Meta-analysis and assignment of quality of evidence by Grading of Recommendations Assessment, Development and Evaluation approach were done.
Forty-one articles qualified for meta-analysis (six IPT, four DPC, and 31 pulpotomy) from 322 screened articles. The 24-month success rates were: IPT=94.4 percent, and the liner material (calcium hydroxide [CH]/bonding agents) had no effect on success (P=0.88), based on a moderate quality of evidence; DP =88.8 percent, and the capping agent (CH/alternate agent) did not affect success (P=0.56), based on a low quality of evidence. The combined success rate for all pulpotomies was 82.6 percent based on 1,022 teeth. Mineral trioxide aggregate (MTA) (89.6 percent) and formocresol (FC) (85.0 percent) success rates were the highest of all pulpotomy types and were not significantly different (P=0.15), with a high quality of evidence. MTA's success rate (92.2 percent) was higher than ferric sulfate (FS) (79.3 percent) and approached significance (P=0.06), while FS's success rate (84.8 percent) was not significantly different from FC (87.1 percent), both with a moderate quality of evidence. MTA and FC success rates were significantly better than CH (P=0.0001), with a moderate quality of evidence. At 18 months, sodium hypochlorite (NaOCl) success rate was significantly less than FC (P=0.01) with a low quality of evidence.
The highest level of success and quality of evidence supported IPT and the pulpotomy techniques of MTA and FC for the treatment of deep caries in primary teeth after 24-months. DPC showed similar success rates to IPT and MTA or FC pulpotomy, but the quality of the evidence was lower. Systematic Review Registration Number: PROSPERO 2015: CRD42015006942.
本系统评价和荟萃分析评估了间接盖髓术（IPT）、直接盖髓术（DPC）和牙髓切断术等活髓治疗（VPT）方法应用于乳牙至少12个月后的治疗效果，以确定哪种VPT方法更具优势。
检索了1960年至2016年9月的以下数据库：MEDLINE、EMBASE、CENTRAL、EBSCO、ICTRP、学位论文摘要以及灰色文献，以查找至少为期12个月的平行和半口随机对照试验，比较IPT、DPC和牙髓切断术治疗乳牙深龋的成功率。我们的主要结局指标为总体成功率（临床和影像学综合评估）。三位作者确定纳入的随机对照试验，进行数据提取，并评估偏倚风险（ROB）。采用推荐分级评估、制定与评价方法进行荟萃分析并确定证据质量。
从322篇筛选出的文章中，有41篇符合荟萃分析标准（6篇IPT、4篇DPC和31篇牙髓切断术）。基于中等质量的证据，24个月时的成功率为：IPT = 94.4%，垫底材料（氢氧化钙[CH]/粘结剂）对成功率无影响（P = 0.88）；DPC = 88.8%，盖髓剂（CH/替代剂）对成功率无影响（P = 0.56），基于低质量的证据。基于1022颗牙齿，所有牙髓切断术的综合成功率为82.6%。三氧化矿物凝聚体（MTA）（89.6%）和甲醛甲酚（FC）（85.0%）的成功率在所有牙髓切断术类型中最高，且无显著差异（P = 0.15），基于高质量的证据。MTA的成功率（92.2%）高于硫酸铁（FS）（79.3%），接近显著差异（P = 0.06），而FS的成功率（84.8%）与FC（87.1%）无显著差异，均基于中等质量的证据。MTA和FC的成功率显著优于CH（P = 0.0001），基于中等质量的证据。在18个月时，次氯酸钠（NaOCl）的成功率显著低于FC（P = 0.01），基于低质量的证据。
最高水平成功率和证据质量支持24个月后IPT以及MTA和FC牙髓切断术治疗乳牙深龋。DPC的成功率与IPT以及MTA或FC牙髓切断术相似，但证据质量较低。系统评价注册号：PROSPERO 2015：CRD42015006942。
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