Pulp treatment for extensive decay in primary teeth

Area of Science:

• Pediatric Dentistry
• Endodontics
• Dental Materials Science

Background:

• Dental caries is a prevalent chronic disease in children worldwide.
• Pulp interventions like direct pulp capping, pulpotomy, and pulpectomy are necessary for extensive decay in primary teeth.
• Common medicaments include Mineral Trioxide Aggregate (MTA), calcium hydroxide, formocresol, and ferric sulphate.

Purpose of the Study:

• To evaluate the effectiveness of various pulp treatment techniques and medicaments for extensive decay in primary teeth.
• To update previous findings on the superiority of pulpotomy medicaments and techniques.

Main Methods:

• Inclusion of 87 randomized controlled trials (RCTs) involving 7140 primary teeth.
• Assessment of clinical and radiological failures at 6, 12, and 24 months.
• Data synthesis using pair-wise meta-analyses with fixed-effect models and assessment of heterogeneity.

Main Results:

• Mineral Trioxide Aggregate (MTA) demonstrated reduced clinical and radiological failures in pulpotomy compared to formocresol and calcium hydroxide.
• Evidence for pulpectomy medicaments (Metapex, zinc oxide and eugenol (ZOE) paste, Endoflas, Vitapex) was inconclusive.
• Direct pulp capping studies were limited, with low-quality evidence and safety concerns regarding formocresol.

Conclusions:

• Pulp treatment for primary teeth with extensive decay is generally successful with low failure rates.
• MTA appears to be the most effective medicament for pulpotomy, though cost is a factor.
• Further research is needed for pulpectomy and direct pulp capping, focusing on alternatives to formocresol due to toxicity concerns.