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Title In Primary Teeth with Deep Carious Lesions, Indirect Pulp Caps and Pulpotomies Are Acceptable Treatment Modalities with High Rates of Success
Clinical Question In primary teeth with deep carious lesions, do indirect pulp caps or pulpotomies have higher rates of success?
Clinical Bottom Line In primary teeth with deep carious lesions, both indirect pulp caps and pulpotomies are acceptable treatment modalities with high rates of success. This is supported by a systematic review and meta-analysis of 39 randomized control trials in which there were similar rates of success for pulpotomies and indirect pulp treatments.
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) 28292337Coll / 20173,709 primary teeth in 2,078 children with large carious lesionsSystematic review of randomized trials
Key resultsIn primary teeth with deep carious lesions, pulpotomy and indirect pulp treatments (IPT or IPC – indirect pulp caps) are acceptable treatment options. Formocresol and MTA pulpotomies were the most highly recommended pulpotomy medications with 'the highest level of success and quality of evidence.' At 24 months, the survival rates for IPT, all pulpotomy types, FC pulpotomy, and MTA pulpotomy were 94.4%, 82.6%, 85.0%, and 89.6% respectively. Important considerations for treatment include the amount of tooth structure affected by caries.
Evidence Search MeSH Terms: vital signs; therapeutics; dental caries; tooth, deciduous; dental pulp
Comments on
The Evidence
Validity: This systematic review clearly addressed multiple focused questions for primary teeth, comparing types of medications for pulpotomies as well as success rates of indirect pulp caps, pulpotomies, and direct pulp capping. The authors searched MEDLINE, CENTRAL, EBESCO, and ICTRP using the GRADE approach. Perspective: This evidence grants the provider the ability to place an indirect pulp cap or a complete pulpotomy with the expectation of achieving relatively similar rates of success depending upon the extension of caries. Indirect pulp treatments showed better success rate at 94.4% compared to pulpotomy technique at 82.6%. Indirect pulp treatment can save time and cost for patients when indicated.
Applicability This systematic review applies directly to the pediatric population with primary teeth with deep caries requiring vital pulp therapy. Although this systematic review gives clear recommendations, it also has limitations. Pulpotomies and indirect pulp treatment techniques were not directly compared statistically.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry)
Keywords Vital Pulp Therapy; Pulpotomy; Indirect Pulp Cap; Primary Teeth; Deciduous Teeth
ID# 3393
Date of submission: 10/31/2019spacer
E-mail foxkc@livemail.uthscsa.edu
Author Kirsten Fox, DDS
Co-author(s) Mark Hoikka, DDS
Co-author(s) e-mail hoikkam@livemail.uthscsa.edu
Faculty mentor/Co-author Dr. Jungyi Alexis Liu, DDS, MS
Faculty mentor/Co-author e-mail LiuJA@uthscsa.edu
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