Tuesday, April 10, 2018

Clinical and radiographic success of mineral trioxide aggregate compared with formocresol as a pulpotomy treatment in primary molars: a systematic review and meta-analysis


Department of Pediatric Dentistry
NYU Langone Dental Medicine - AEPD

Resident’s Name: Albert Yamoah, DDS                                                                                                      Date: 4/13/2017
Article Title Clinical and radiographic success of mineral trioxide aggregate compared with formocresol as a pulpotomy treatment in primary molars: a systematic review and meta-analysis.
Author(s):  Marghalani AA, Omar S, Chen JW
Journal:  Journal of American Dental Association
Date: 2014
Major Topic: Pulpotomy, pulp-dressing material
Type of Article: Systematic review and meta-analysis
Main Purpose: Long-term clinical and radiographic success of using mineral trioxide aggregate (MTA) and formocresol (FC) in primary molars pulpotomy
Key Points
·       On the basis of the limited evidence, pulpotomy procedures performed in primary molars involving the use of MTA or FC showed comparable clinical success rates

Background
·       The pulpotomy procedure is the most common pulp therapy for severely carious asymptomatic primary molars that have vital pulp
·       Multiple treatment protocols have been researched and implemented to determine which technique or material is superior
·       Two treatments of long standing involve the agents formocresol (FC) and mineral trioxide aggregate (MTA)

Purpose
·       Compare the long-term clinical and radiographic success of using mineral trioxide aggregate (MTA) and formocresol (FC) as a pulp-dressing material in pulpotomy treatment in primary molars

Methods
·       Used the population, intervention, comparison, outcomes and study design (PICOS) method to develop a search strategy and to establish inclusion and exclusion criteria
·       The authors identified 20 trials and included five of them
·       A total of 377 primary molars were treated
·       The authors judged that none of the included RCTs had a low risk of bias

Results
·       100% success rate observed in primary molars treated with MTA (n = 156), with no reported clinical failures
·       For the molars treated with FC (n = 161), the success rate was 98.8 percent, with only two documented clinical failures
·       No significant heterogeneity noted among the included RCTs (P = .99; I 2 = 0 percent)
·       No significant difference noted in the likelihood of clinical success between primary molars treated with MTA and primary molars treated with FC
·       Radiographic success rate of 96.2% for primary molars treated with MTA (n = 156); only six radiographic failures were documented
·       For the FC group (n = 161), 84.5 percent success rate – observed 25 radiographic failures
·       Significant heterogeneity noted among the included RCTs (P = .05; I 2 = 58 percent)
·       There was no significant difference in the likelihood of radiographic success’ occurring for primary molars treated with MTA as compared with those treated with FC

Conclusion
·       None of the included RCTs have a low risk of bias
·       No significant differences noted in clinical success and radiographic success for primary molars treated with MTA versus those treated with FC
·       On the basis of the limited evidence, MTA and FC demonstrated comparable clinical success rates
Assessment of Article:  Level of Evidence/Comments: Level I evidence – meta-analysis
·       To infer strong evidence, investigators are encouraged to conduct high-quality RCTs with longer follow-up periods than those used by the investigators in the trials included in this review, superior methodology and lower risk of bias
·       Of the 20 eligible trials, we considered only five in this review.
·       Moreover, three of the five trials had a high risk of bias and none had a low risk of bias. Strict inclusion criteria may be a limitation of this study, as we excluded some well-designed trials with valuable information owing to the short observational time, the lack of a clear clinical protocol or the lack of randomization



No comments:

Post a Comment