Thursday, April 20, 2017

Mineral trioxide aggregate as a pulpotomy medicament: an evidence-based assessment

Mineral trioxide aggregate as a pulpotomy medicament: an evidence-based assessment.
Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Jonathan Kaczmarski   Date: 04/20/2017
Article Title:
 Mineral trioxide aggregate as a pulpotomy medicament: an evidence-based assessment.
Author(s): Ng FK, Messer LB
Journal: European Archives of Pediatric Dentistry
Date: 2008
Major Topic: MTA in Pulpotomies
Type of Article: Review Article
Main Purpose: Use the principles of EBD to answer a compare the efficacy of MTA, FC, FS and CH as primary molar pulpotomy medicaments.
Key Points: (2 lines Max): Main conclusion or the most interesting


Aim:
The principles of evidence-based dentistry were used to compare MTA, formocresol (FC), ferric sulphate (FS) and calcium hydroxide (CH) as primary molar pulpotomy medicaments.
FC: Clinical success has been attributed to the antimicrobial characteristics but success rates decline in the long term: Zone of necrosis à zone of fixation à inflammatory infiltration à normal pulp /
Histologic findings in pulps treated with FC range from total necrosis to vital pulp with inflammation.
FS agglutinates blood proteins and a ferric ion-protein complex seals blood vessels mechanically àhemorrhage control à prevention of blood clot formation and chronic inflammation
(In animal histological studies have shown FS and FC produce similar pulpal responses).
CH is more technique sensitive than FC, and extensive IR may follow. The IR may be related to the residual (clot prior to CH application, previous chronic inflammation of radicular pulp or the inability of CH to provide a long-term seal resulting in bacterial microleakage and pulp inflammation).

Methods:
Literature was searched for relevant papers by (titles, abstracts and full texts). Included were randomized clinical trials (RCTs) and clinical trials (CTs) comparing the clinical and radiographic successes of MTA, FC, FS and CH pulpotomies. Data were extracted and common odds ratios (CORs) were derived by fixed effects meta-analysis. Mean clinical and radiographic success rates from relevant study were examined.

Results:
18 RCTs and 10 CTs (total 1,260 molars) were identified to compare MTA and FC. Direct MAs found MTA was significantly more successful clinically and radiographically than FC.

14 RCTs and 4 CTs (total 959 molars) were identified to compare MTA and FS. Clinical and radiographicdata showed MTA was significantly more successful than FS. Indirect MAs found no statistically significant difference in clinical successes, but a statistically significant difference in the radiographic successes of MTA and FS.

9 RCTs and 7 CTs (total 531 molars) were identified to compare MTA and CH. Indirect MAs found statistically significant differences in the clinical and radiographic successes of MTA and CH. Clinical and radiographic data confirmed MTA was significantly more successful than CH.

Conclusion:
Currently available evidence suggests MTA compared with FC, FS and CH as a pulpotomy medicament resulted in significantly higher clinical and radiographic successes in all time periods up to exfoliation.

Remarks:
1-     Results due to the better seal in MTA?
2-
Assessment of Article:  Level of Evidence/Comments:

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