ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Coronal Pulpotomy Can Be an Effective Alternative to Conventional Root Canal Treatment
Clinical Question In patients with cariously exposed vital pulp in permanent teeth with closed apices, is coronal pulpotomy as successful as conventional root canal treatment?
Clinical Bottom Line Coronal pulpotomy should be considered as an alternative to root canal treatment in patients with cariously exposed vital pulp in permanent teeth with closed apices. This is supported by a systemic review and meta analysis. The systemic review reported significant success rates for treatment with coronal pulpotomy treatment. This treatment is likely to be beneficial to maintain the defense mechanisms of a vital pulp and is a more affordable option for patients who cannot financially afford to undergo root canal treatment.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26687672Alqaderi/2016265 patients in 6 included studiesSystematic Review & Meta-Analysis
Key resultsPatients treated with coronal pulpotomy for cariously exposed vital pulp in permanent teeth with closed apices showed successful treatment rates of >90% at 1-year and 2-year follow-up evaluations. The weighted mean success rate (WSR) estimated from the DerSimonian-Laird random effects model was used for the measured outcome. With 95% confidence interval (CI), the one-year and two-year WSR were 94% (95% CI: 90, 99) and 92% (95% CI: 84, 100) respectively. The weighted mean for 1-year and 2-year success rates were 63.6% and 83.8%, respectively, showing significant heterogeneity among the studies. In addition, differences in pulp capping and restoration materials did not significantly affect success rates. The 2-year WSR of pulpotomies performed with the use of mineral trioxide aggregate (MTA) and MTA-like products (bioceramics) group vs. the calcium hydroxide group was 92% (95% CI: 85, 99) vs. 88% (95% CI: 76, 100) and the amalgam group vs. the composite group was 92% (95% CI: 81, 100 vs. 93% (95% CI: 81,100).
Evidence Search Coronal pulpotomy AND root canal treatment
Comments on
The Evidence
Validity: The article is a systematic review and meta-analysis. There were 265 patients in 6 included studies. One study was a randomized controlled trial, and the rest were prospective or retrospective cohort studies. A comprehensive and detailed search for relevant trials with predetermined criteria was employed. Articles from the years 1960 to 2015 were screened. Individual studies were assessed for validity by incorporating two quality assessment methods including the Cochrane Collaboration’s tool for the randomized control trial study and the Newcastle-Ottawa scale for the other studies. Perspective: A direct comparison of success rates between coronal pulpotomy treatment and root canal treatment could not be performed, because only one included study (the randomized control trial study) reported the success rates of the two groups. In addition, although only one randomized control trial study was used, the studies within this systematic review represent the most current evidence. This systemic review showed that coronal pulpotomy was successful in managing patients with cariously exposed vital pulp in permanent teeth with closed apices. However, further large-scale clinical control trials with longer follow-up periods should be done.
Applicability Neither gender nor the ethnicity of the participants was indicated in the studies. Pretreatment diagnostic criteria was inconsistent among the included studies, as some treated symptomatic patients and others treated non-symptomatic patients. There were a limited number of studies selected, which could bias the results. However, the combined studies included patients with a broad age range of 7-70 and all used a consistent definition of a successful outcome, which was an absence of clinical symptoms and no radiographic pathology. Coronal pulpotomy treatment should be considered as an alternative to root canal treatment for patients when root canal treatment is not financially feasible or as a regenerative approach to favor the maintenance of pulp vitality and its defense mechanisms against re-infection. This treatment should be strongly linked with regular follow-up visits in order to assess and address any defective restoration to ensure the integrity of the pulp.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords Coronal pulpotomy, root canal treatment, permanent dentition
ID# 3044
Date of submission: 04/29/2016spacer
E-mail GARCIAO3@livemail.uthscsa.edu
Author Octavio Garcia, MD
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Anibal Diogenes, DDS, MS, PhD
Faculty mentor/Co-author e-mail DIOGENES@uthscsa.edu
Basic Science Rationale
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