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Effectiveness of different obturation materials in primary teeth: A network meta-analysis
Arun Kumar Patnana1, A Rizwan Ali2, Divya Narayanan1
1Department of Dentistry, All India Institute of Medical Sciences, Rajkot, Gujarat, India.
Background:
Selecting an ideal obturation material is important for the success of pulpectomy in primary teeth. Definitive evidence is lacking in suggesting an ideal obturation material in the literature.
Aim:
The current Network Meta-Analysis (NMA) aimed to assess the effectiveness of various obturation materials in primary teeth.
Methodology:
A systematic search was conducted across four electronic databases for selecting eligible Randomized Controlled Trials (RCTs). Two independent reviewers screened studies, extracted data, and evaluated the risk of bias (RoB) using the Cochrane RoB 2 tool. Data synthesis utilized a Bayesian random-effects model, and Odds Ratios (ORs) were calculated for the dichotomous overall success outcome. The ranking of obturation materials was performed using the SUCRA ranking method. All statistical analyses were carried out with the MetaInsight software. The certainty of evidence for all treatment comparisons was evaluated using the GRADE approach, complemented by the Confidence in Network Meta-Analysis web application.
Results:
NMA assessed over 1608 patients and 19 different combinations of obturation materials from 47 studies. Only eight among 47 included articles have shown a low RoB. The quantitative analysis showed the ZOE, CH, and Iodoform-based paste (Endoflas) demonstrated one of the best effect estimates (OR ≈ 0.35; 95% confidence interval 0.11-1.17). The overall certainty of evidence was low to very low, considering the methodological pitfalls and small sample size in the included studies.
Conclusion:
The combination of ZOE, CH, and Iodoform-based paste (Endoflas) can be considered as a viable option as an obturation material in primary teeth with low certainty of evidence.
