Dhar Vineet, Marghalani Abdullah A, Crystal Yasmi O, Kumar Ashok, Ritwik Priyanshi, Tulunoglu Ozlem, Graham Laurel
VPT workgroup chair, is a clinical associate professor and chief, Division of Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md., USA.
Pediatric dental fellow, Division of Pediatric Dentistry, at the University of Maryland School of Dentistry, Baltimore, Md., USA.
Pediatr Dent. 2017 Sep 15;39(5):146-159.
This manuscript presents evidence-based guidance on the use of vital pulp therapies for treatment of deep caries lesions in children. A guideline panel convened by the American Academy of Pediatric Dentistry formulated evidence-based recommendations on three vital pulp therapies: indirect pulp treatment (IPT; also known as indirect pulp cap), direct pulp cap (DPC), and pulpotomy.
The basis of the guideline's recommendations was evidence from "Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-Analysis." (Pediatr Dent 2017;15;39[1]:16-23.) A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and trial databases to identify randomized controlled trials and systematic reviews addressing peripheral issues of vital pulp therapies such as patient preferences of treatment and impact of cost. Quality of the evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation approach; the evidence-to-decision framework was used to formulate a recommendation.
The panel was unable to make a recommendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions. The panel recommends use of mineral trioxide aggregate (MTA) and formocresol in pulpotomy treatments; these are recommendations based on moderate-quality evidence at 24 months. The panel made weak recommendations regarding choice of medicament in both IPT (moderate-quality evidence [24 months], low quality evidence [48 months]) and DPC (very-low quality evidence [24 months]). Success of both treatments was independent of type of medicament used. The panel also recommends use of ferric sulfate (low-quality evidence), lasers (low-quality evidence), sodium hypochlorite (very low-quality evidence), and tricalcium silicate (very low-quality evidence) in pulpotomies; these are weak recommendations based on low-quality evidence. The panel recommended against the use of calcium hydroxide as pulpotomy medicament in primary teeth with deep caries lesions. Conclusions and practical implications: The guideline intends to inform the clinical practices with evidence-based recommendations on vital pulp therapies in primary teeth with deep caries lesions. These recommendations are based upon the best available evidence to-date.
本手稿提供了关于使用牙髓活力治疗方法治疗儿童深龋病变的循证指南。由美国儿科学会召集的一个指南小组针对三种牙髓活力治疗方法制定了循证建议：间接盖髓术（IPT；也称为间接盖髓）、直接盖髓术（DPC）和牙髓切断术。
该指南建议的依据来自《乳牙牙髓活力治疗：系统评价与荟萃分析》（《儿科牙科学》2017年；15；39[1]：16 - 23）。在PubMed®/MEDLINE、Embase®、Cochrane对照试验中央注册库和试验数据库中进行了系统检索，以识别针对牙髓活力治疗周边问题的随机对照试验和系统评价，如患者的治疗偏好和成本影响。通过推荐分级评估、制定和评价方法评估证据质量；使用证据 - 决策框架来制定建议。
由于缺乏直接比较这些干预措施的研究，该小组无法就任何特定类型的牙髓活力治疗方法的优越性提出建议。该小组建议在牙髓切断术中使用三氧化矿物凝聚体（MTA）和甲醛甲酚；这些是基于24个月时中等质量证据的建议。该小组对IPT（中等质量证据[24个月]，低质量证据[48个月]）和DPC（极低质量证据[24个月]）中药物的选择提出了微弱建议。两种治疗方法的成功与否与所用药物的类型无关。该小组还建议在牙髓切断术中使用硫酸铁（低质量证据）、激光（低质量证据）、次氯酸钠（极低质量证据）和硅酸三钙（极低质量证据）；这些是基于低质量证据的微弱建议。该小组不建议在患有深龋病变的乳牙中使用氢氧化钙作为牙髓切断术药物。结论及实际意义：该指南旨在为临床实践提供关于患有深龋病变乳牙牙髓活力治疗的循证建议。这些建议基于迄今为止可得的最佳证据。
