Jakovljevic Aleksandar, Jaćimović Jelena, Aminoshariae Anita, Fransson Helena
Department of Pathophysiology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
Central Library, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
Int Endod J. 2023 Oct;56 Suppl 3:340-354. doi: 10.1111/iej.13776. Epub 2022 May 25.
The exposed pulp has been the topic of numerous studies, but well-designed and well-executed comparative trials on the outcome and treatment of these teeth have been limited.
This study was conducted to answer the following questions: in patients with nontraumatic pulpitis associated with no or nonspontaneous pain in permanent teeth, (i) is direct pulp capping or pulpotomy (partial/full) as effective as selective or stepwise caries removal [Population/participants, Intervention(s), Comparator(s)/control, Outcome(s) (PICO) 1], (ii) is pulpotomy (partial/full) as effective as direct pulp capping (PICO 2) and (iii) is pulpotomy (partial/full) as effective as a pulpectomy (PICO 3), in terms of a combination of patient and clinical reported outcomes, with 'tooth survival' as the most critical outcome?
A literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials from inception to November 3rd 2021. Grey literature and contents of the major subject journals were examined. Eligibility criteria followed the PICO questions. Two independent reviewers performed study selection, data extraction and appraisal; disagreements were resolved by a third reviewer. The risk of bias was assessed by the revised Cochrane risk-of-bias tool for randomized trials.
Three randomized clinical trials (RCTs) were included in the review. No study fulfilled the criteria to answer PICO 1. There were no significant differences in the reported outcomes between investigated treatments in all included RCTs. None of the included studies reported the most critical outcome 'tooth survival'. A high loss of patients during the follow-up period was observed.
Although a few studies fulfilled strict eligible criteria, the results of this systematic review clearly highlight a paucity of available evidence. At the present time, clinical decisions cannot be substantiated by direct comparative trials.
Based on limited evidence, this systematic review discovered no significant differences in effectiveness between compared vital pulp treatments in managing nontraumatic pulpitis associated with no or nonspontaneous pain. Further high-quality RCTs are necessary to investigate the effectiveness of direct pulp capping or pulpotomy (partial/full) compared to selective or stepwise caries removal.
PROSPERO database (CRD42021259742).
露髓一直是众多研究的主题，但关于这些牙齿的治疗结果且设计良好、执行完善的对比试验却很有限。
本研究旨在回答以下问题：对于恒牙患有非创伤性牙髓炎且无自发痛或偶发痛的患者，（i）直接盖髓术或牙髓切断术（部分/全部）与选择性或逐步去龋术相比是否同样有效[人群/参与者、干预措施、对照/控制措施、结果（PICO）1]，（ii）牙髓切断术（部分/全部）与直接盖髓术相比是否同样有效（PICO 2），以及（iii）牙髓切断术（部分/全部）与牙髓摘除术相比是否同样有效（PICO 3），从患者和临床报告结果综合来看，以“牙齿留存”作为最关键结果？
使用科睿唯安的《科学引文索引》《Scopus数据库》《PubMed》以及Cochrane对照试验中心注册库进行文献检索，检索时间范围从建库至2021年11月3日。对灰色文献和主要学科期刊内容进行了审查。纳入标准遵循PICO问题。两名独立评审员进行研究筛选、数据提取和评估；分歧由第三名评审员解决。采用修订后的Cochrane随机试验偏倚风险工具评估偏倚风险。
本综述纳入了三项随机临床试验（RCT）。没有研究符合回答PICO 1的标准。在所有纳入的RCT中，所研究的治疗方法在报告结果上没有显著差异。纳入的研究均未报告最关键的结果“牙齿留存”。在随访期间观察到大量患者失访。
尽管有少数研究符合严格的纳入标准，但本系统评价的结果清楚地表明现有证据不足。目前，临床决策无法通过直接对比试验得到证实。
基于有限的证据，本系统评价发现，在治疗与无自发痛或偶发痛相关的非创伤性牙髓炎时，所比较的活髓治疗方法在有效性方面没有显著差异。需要进一步开展高质量的RCT，以研究直接盖髓术或牙髓切断术（部分/全部）与选择性或逐步去龋术相比的有效性。
PROSPERO数据库（CRD42021259742）
