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摘要
Selection Criteria The literature search included MEDLINE (via PubMed), Science-Direct, Web of Science, Cochrane, and Clinical Key databases up to December 2012. Original prospective clinical trials comparing two or more pulpotomy agents were identified. The three authors did the search and started screening titles and abstracts for potential relevant articles, then performed a quality assessment of the included articles. Any disagreements were resolved by discussion among them. A total of 2083 potential relevant titles, abstracts, and articles were identified in addition to reference lists of reviews and related articles, with 171 articles screened for further evaluation. Finally, 37 trials met all the inclusion criteria, and 22 were considered for network and pair-wise meta-analyses. Of all 37 studies, 22 were parallel trials and the others were split-mouth trials. Follow-up periods were diverse, ranging from 5.2 to between 48 and 60 months. Twenty-two studies were chosen for meta-analyses for 912 months, and 12 were chosen for meta-analyses for 1824 months. The majority of the studies were randomized controlled trials (RCTs). Key Study Factor The review included human clinical trials comparing two or more pulpotomy agents to treat vital primary molars with carious pulp exposure. Only studies with follow-up periods of 6 months or more were considered. Studies were required to have clear reporting of clinical or radiographic success and failure rates to be included in the systematic review. The final network meta-analysis included five commonly used medicaments for primary molar pulpotomies: formocresol, ferric sulfate, calcium hydroxide, mineral trioxide aggregate (MTA), and laser therapies. Main Outcome Measure Clinical and radiographic outcome among different pulpotomy treatments for primary molars after follow-up periods of 9-12 months and 18-24 months. Main Results Thirty studies out of the identified 37 were described as randomized, 11 of which clearly described the randomization methods. There were no trials that employed double blinding, and only 2 trials performed patient blinding. Four of the included trials reported sample size and statistical power calculations. The results of network meta-analysis of clinical and radiographic outcome for primary molar pulpotomy after 9-12 month follow-up (Table 3 in the article) indicated that formocresol had significantly better clinical outcomes than calcium hydroxide. MTA had significantly better clinical outcomes than formocresol and calcium hydroxide, and better radiographic outcome than formocresol, ferric sulfate, and calcium hydroxide. Calcium hydroxide had more clinical and radiographic failures than formocresol and ferric sulfate after 9-12 months. The authors reported that after 18-24 months, formocresol, ferric sulfate, and MTA had significantly better clinical outcomes than calcium hydroxide and laser therapies (Table 4 in the article). Calcium hydroxide and laser treatments had two and three times more failures than formocresol, ferric sulfate, and MTA, respectively. Results of the pair-wise meta-analysis were similar to those from the network meta-analysis. Trials with 100% success rates of both treatments were excluded from the pair-wise meta-analysis. Conclusions MTA had significantly better clinical and radiographic outcomes than formocresol and calcium hydroxide, and calcium hydroxide had more failures than formocresol and ferric sulfate after 9-12 months. After 1824 months, formocresol, ferric sulfate, and MTA had significantly better clinical and radiographic outcomes than calcium hydroxide and laser therapies in primary molar pulpotomies.
- 出版日期2015-6
