Better outcomes in pulpotomies on primary molars with MTA

Medline, Cochrane Library, Embase, Science Citation Index and the China National Knowledge Infrastructure were used to source articles. In addition, identified papers' reference lists and their authors' other published literature were also scanned.

Studies of interest were randomised controlled trials of primary molar teeth where there was exposure of vital pulp caused by caries or trauma, with at least 6 months follow-up. It was required that selected teeth had no internal root resorption, inter-radicular and periapical bone destruction, no periodontal involvement, swelling, or sinus tract; they should be restorable with stainless steel crowns; and that outcomes were evaluated by clinical symptoms and radiographic evidence where the comparison followed a standard definition of success or failure, as shown by the number of teeth.

Data were extracted from each study independently and entered into a database. Differences were resolved by discussion. Studies were scored for validity criteria according to the Jadad scale. Meta-analysis was performed using the software RevMan (version 4.2.8; Copenhagen; The Nordic Cochrane Centre, The Cochrane Collaboration, 2003). Heterogeneity between studies was assessed using a standard chi-square test. If there was homogeneity among the studies, the fixed-effect model (Peto method) was applied to aggregate the data. If homogeneity was rejected then sensitivity analyses were performed using a random-effects model.

Six studies met the inclusion criteria (giving a total of 381 teeth). There was a significant difference between the success rates of formocresol (FC)- and mineral trioxide aggregate (MTA)-treated pulpotomised primary molars (P<0.05) Clinical assessments and radiographic findings of the MTA versus FC pulpotomy suggested that MTA was superior to FC in pulpotomy, resulting in a lower failure rate [relative risk, 0.32 (95% confidence interval, 0.11-0.90) and 0.31 (95% confidence interval, 0.13-0.74) respectively].

The results demonstrate that in primary molar teeth with vital pulp exposure caused by caries or trauma, a pulpotomy performed with MTA results in better clinically and radiographically observed outcomes. Fewer undesirable responses were recorded for MTA than when FC was used. Therefore, the study supports the use of MTA instead of FC as wound dressing when performing pulpotomies on primary molars.