Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
J Evid Based Dent Pract. 2019 Mar;19(1):17-27. doi: 10.1016/j.jebdp.2018.05.002. Epub 2018 May 31.
Pulpotomy is the favored treatment for pulp exposure in carious primary teeth. This review aimed to compare the success rates of biodentine (BD) and mineral trioxide aggregate (MTA) pulpotomies in primary molars using meta-analysis (MA) and trial sequential analysis (TSA) and also to assess the quality of the results by Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
PubMed, EBSCOhost, and Scopus databases were searched. Additional searching was performed in clinical trial registry, reference lists of systematic reviews, and textbooks. Randomized clinical trials (RCTs) published in the English language through October 2017 comparing the success of pulpotomies in vital primary molars with a follow-up of at least 6 months were selected. Study selection, data extraction, and risk of bias assessment were performed. MA by random effects model, TSA, and GRADE were performed.
Eight RCTs (n = 474) were included. Two RCTs had low risk of bias. No significant difference was observed between MTA and BD in clinical success at 6 months (risk ratio [RR], 1.00; 95% confidence interval [95% CI], 0.97-1.02; I2 = 0%), 12 months (RR, 1.00; 95% CI, 0.96-1.05; I2 = 0%), and 18 months (RR, 1.00; 95% CI, 0.93-1.08; I2 = 0%). No difference was observed in radiographic success at follow-up of 6 months (RR, 0.99; 95% CI, 0.96-1.02; I2 = 0%), 12 months (RR, 1.02; 95% CI, 0.47-2.21; I2 = 0%), and 18 months (RR, 1.02; 95% CI, 0.91-1.15; I2 = 0%). TSA indicated lack of firm evidence for the results of the meta-analytic outcomes on clinical and radiographic success. GRADE assessed the evidence from the MA comparing the effect of MTA and BD in pulpotomy to be of low quality.
BD and MTA have similar clinical and radiographic success rates based on limited and low-quality evidence. Future high-quality RCTs between MTA and BD is required to confirm the evidence.
活髓切断术是治疗龋源性恒牙牙髓暴露的首选方法。本研究旨在通过荟萃分析（MA）和序贯试验分析（TSA）比较生物陶瓷（BD）和三氧化矿物聚合体（MTA）在恒磨牙活髓切断术中的成功率，并通过推荐评估、制定与评估分级（GRADE）评估结果质量。
检索了 PubMed、EBSCOhost 和 Scopus 数据库，还对临床试验注册库、系统评价的参考文献列表和教科书进行了额外的检索。纳入了在 2017 年 10 月前以英文发表的比较活髓切断术在有活力的恒牙中成功率的随机临床试验（RCT），随访时间至少为 6 个月。进行了研究选择、数据提取和偏倚风险评估。采用随机效应模型进行 MA、TSA 和 GRADE。
纳入了 8 项 RCT（n=474）。有 2 项 RCT 为低偏倚风险。在 6 个月（风险比[RR]，1.00；95%置信区间[95%CI]，0.97-1.02；I2=0%）、12 个月（RR，1.00；95%CI，0.96-1.05；I2=0%）和 18 个月（RR，1.00；95%CI，0.93-1.08；I2=0%）时，MTA 和 BD 在临床成功率方面无显著差异。在 6 个月（RR，0.99；95%CI，0.96-1.02；I2=0%）、12 个月（RR，1.02；95%CI，0.47-2.21；I2=0%）和 18 个月（RR，1.02；95%CI，0.91-1.15；I2=0%）时，X 线成功率无差异。TSA 表明，Meta 分析结果在临床和放射学成功率方面缺乏确凿证据。GRADE 评估了 MA 比较 MTA 和 BD 在活髓切断术中效果的证据质量为低质量。
基于有限的低质量证据，BD 和 MTA 具有相似的临床和放射学成功率。需要进行高质量的 RCT 来比较 MTA 和 BD，以确认证据。
