ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title The Effect Of A Total Etch Adhesive System Versus Calcium Hydroxide In Pulpal Protection Of Primary Molars
Clinical Question In the pediatric patient with carious lesions in primary molars, does the use of a total etch dental adhesive system (Scotchbond Multipurpose) offer greater pulpal protection subsequent to cavity preparation as compared to a calcium hydroxide liner?
Clinical Bottom Line The use of a total etch adhesive system offers comparable protection of the pulp complex as compared to calcium hydroxide liners. (See Comments on the CAT below)
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) 17896116Büyükgüral/200897 children ages 5-10Randomized Controlled Trial
Key resultsThere was no significant difference in pulpal response when protected with the total etch adhesive versus the calcium hydroxide liner. The reported p value was less than 0.180, and the authors affirmed the difference between the two conditions was negligible. An overall conclusion that pulpal protection is not necessarily material dependant was made.
#2) 12064499Falster/200248 primary molars from 3-5 year old childrenRandomized Controlled Trial
Key resultsThere was no marked difference in pulpal health, and thus, no marked difference in success rates of restored primary molars with the total etch adhesive system and the calcium hydroxide liner. The reported p value for this study was 0.350. The authors concluded that the marginal seal attained using the adhesive system provided comparable results to the use of the calcium hydroxide liner with respect to preservation of pulpal health.
Evidence Search ("Dental Pulp Capping"[Mesh] AND "Calcium Hydroxide"[Mesh]) AND "Tooth, Deciduous"[Mesh]
Comments on
The Evidence
With respect to the validity of these articles, the patient group is considered similar at the start of the trial period since there existed specific criteria for the qualification of each of the participants. The children selected had large carious lesions but without signs of irreversible pulpal damage. Both trials exhibited a greater than 80% completion rate among participants. Both trials utilized a calcium hydroxide control and the total etch (Scotchbond Multipurpose) as the adhesive system. The first study included a 2-year follow-up period where the clinical and radiographic effectiveness of the treatments were analyzed. The second study evaluated teeth clinically and radiographically over a 2-year period. Compliance among participants was adequate and the occurrence of recall bias is unlikely since there were no competing interests associated with the trial.
Applicability Evaluating the validity of the identified articles, it was determined that the subjects were not entirely representative of a general dentistry practice. The patient pool used in these studies consisted of pediatric patients. This group is more representative of a pediatric dentistry focused practice and not necessarily a general dental practice. The treatment administered however is feasible in a general dentistry setting and has numerous advantages that take the patients’ best interest into account.
Specialty/Discipline (Pediatric Dentistry) (Restorative Dentistry)
Keywords Dental Pulp Capping, Calcium Hydroxide, Deciduous Teeth
ID# 598
Date of submission: 04/01/2010spacer
E-mail konkright@livemail.uthscsa.edu
Author Ryan Konkright
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Karen Troendle, DDS
Faculty mentor/Co-author e-mail TROENDLE@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Kyle King, John Vogel, Christina Gonzalez (San Antonio, TX) on 01/07/2013
We conducted a PubMed search in January of 2013, PMID 23019833 . This article, an RCT, further validated this CAT in that there was no significant difference in treatment using Calcium Hydroxide liner versus total etch systems.
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