| Title |
Lesion Sterilization and Tissue Repair (LSTR) Favors Pulpectomies when Preoperative Root Resorption Is Present |
| Clinical Question |
In nonvital primary teeth, what is the effect of LSTR on the treatment success rate compared to pulpectomy? |
| Clinical Bottom Line |
When performing nonvital pulp therapy for primary teeth, pre-operative root resorption can help us decide between pulpectomies vs. LSTR. In the absence of root resorption, the success rate of pulpectomy is higher, even though the difference is not statistically significant. After doing 5 nonvital pulp therapy, one failure may be avoided doing pulpectomies. The quality of evidence was low due to serious heterogeneity in the studies. In the presence of root resorption, LSTR success rate is statistically significantly higher and after doing 4 nonvital pulp therapy, one failure may be avoided doing LSTR. The level of evidence was moderate. Not considering preoperative root resorption, pulpectomies have higher (but not statistically significant) clinical and radiographic success rate after 6, 12, and 18 months with quality of evidence ranging from moderate to very low. |
| Best Evidence |
|
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| 32847665 | Coll/2020 | 6 articles included in meta analysis | Meta-Analysis | | Key results | If no external or internal root resorption has occurred, the success rate of pulpotomy after 12 months, regardless of the medicament used, is 92% and the success rate of LSTR is 65%. Meta analysis showed no statistical difference (RR = 0.77; 95% CI, 0.56 to 1.05). The NNT = 5, indicating that using pulpectomy instead of LSTR for 5 teeth may avoid one failure at 1 year.
If external or internal root resorption has occurred, the success rate of pulpotomy after 12 months, regardless of the medicament used, is 47% and the success rate of LSTR is 76%. Meta analysis showed a statistical difference (RR = 1.65; 95% CI, 1.31 to 2.08). The NNT = 4, indicating using LSTR instead of pulpectomy for 4 teeth may avoid one failure at 1 year. | | 32666347 | Duarte/2020 | 6 articles included in systematic review and 4 in the meta analysis | Meta-Analysis | | Key results | Even though the clinical success rate at 6 months [RR = 0.99; 95% CI, 0.94 to 1.04]; 12 months [RR = 0.97; 95% CI, 0.90 to 1.04]; 18 months [RR=0.89 CI, 0.77– 1.04], and the radiographic success rate at 6 months [RR = 0.91; 95% CI, 0.78 to 1.06]; 12 months [RR = 0.87; 95% CI, 0.65 to 1.18] and 18 months [RR=0.84; 95% CI, 0.69 to 1.02] was greater for pulpectomy than LSTR, these differences were not statistically significant. Meta analysis was unable to reveal any difference between pulpectomy vs LSTR irrespective of follow-up time (6,12,18 months) or method of evaluation (clinical vs radiographic). | |
| Evidence Search |
pulpectomy, nonvital pulp therapy, primary teeth, Lesion Sterilization and Tissue Repair (LSTR) |
Comments on
The Evidence |
Validity: Both systematic reviews and meta analyses were performed following the guidelines proposed by PROSPERO. Inclusion and exclusion criteria were well defined. However, the level of evidence ranged from very low to moderate. This is due to the high heterogeneity as seen in the I2 values as well as imprecision based on the sample sizes. This is because there are not solid clinical trial studies. Both studies reviewed the same articles, but with different perspectives (radiographic and clinical success at different time points vs presence or absence of root resorption).
Perspective: The systematic review and meta analysis by Duarte showed no significant difference in success rate between pulpectomy and LSTR. However, Coll’s systematic review and meta analysis took into consideration the pre-operative status of the tooth (presence or absence of root resorption) and had a different result as a consequence. Based on Coll’s systematic review, in the presence of root resorption, LSTR has a significantly higher success rate than pulpectomy. In the absence of root resorption, even though not statistically significant pulpectomy has a higher success rate than LSTR. The NNT of 5 seems to be a persuasive factor in selecting pulpectomy over LSTR in those cases.
|
| Applicability |
When performing nonvital pulp therapy for a pediatric patient, several factors should be considered including medical history of the patient, how long the primary teeth are expected to be retained, accessibility of care, and behavior of the patient. For example, when the success rate of LSTR is 76% when pre-operative root resorption is diagnosed, almost one-fourth of the cases will fail. Even though in that case LSTR has a higher success rate than pulpectomy based on Coll’s systematic review, extraction might be an appropriate treatment for a patient who is receiving chemotherapy or for a patient whose dental treatment can only be rendered in a hospital setting, or for a patient with very limited access to dental care. In an ideal situation, both treatments cost almost the same and require almost the same amount of time. |
| Specialty |
(Endodontics) (Pediatric Dentistry) |
| Keywords |
pulpectomy, LSTR, nonvital pulp therapy, primary teeth,Lesion Sterilization and Tissue Repair (LSTR)
|
| ID# |
3457 |
| Date of submission |
11/30/2020 |
| E-mail |
moaven@uthscsa.edu |
| Author |
Nima Moaven |
| Co-author(s) |
Leah Reimnitz |
| Co-author(s) e-mail |
reimnitz@livemail.uthscsa.edu |
| Faculty mentor |
Dr. Anibal Diogenes |
| Faculty mentor e-mail |
diogenes@uthscsa.edu |
| |
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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?) |
| None available | |
 |
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
| None available | |