When I was training formocresol was the standard dressing for primary teeth following pulpotomy . However, it  use is now questionable because of potential adverse effects such as potential carcinogenicity, mutagenicity, and cytotoxicity.  Consequently a range of other materials have been investigated,  ferric sulphate, gluatraldehyde preparations , mineral trioxide aggregate (MTA), electrosurgery, calcium hydroxide, and laser therapies .  The aim of this review was to compare the clinical and radiographic outcomes in primary molar pulpotomy of different dressing materials.

Searches were conducted in the Medline, ScienceDirect, Web of Science, Cochrane, and Clinical Key databases for prospective clinical trials with follow-up periods of 6 months or more comparing two or more pulpotomy agents. Three reviewers conducted trial selection data abstraction and quality assessment. To incorporate direct and indirect evidence, network meta-analyses were undertaken using the Bayesian hierarchical random-effects modeling.

• 37 studies were included with 22 studies contributing to the final network meta-analyses
• Five commonly used medicaments; formocresol, ferric sulfate, calcium hydroxide, MTA, and laser therapies were assessed.
• 22 of the studies were parallel trials, 15 split-mouth studies.
• After 18-24 months, in terms of treatment failure, the odds ratios were:-
  • 1.94 [95% credible interval (CI): 1.11, 3.25]; for calcium hydroxide vs. formocresol
  • 3.88 (95% CI: 1.37, 8.61) for lasers vs. formocresol;
  • 2.16 (95% CI: 1.12, 4.31) for calcium hydroxide vs. ferric sulphate;
  • 3.73 (95% CI: 1.27, 11.67) for lasers vs. ferric sulphate;
  • 0.47 (95% CI: 0.26, 0.83) for MTA vs. calcium hydroxide;
  •  3.76 (95% CI: 1.39, 10.08) for lasers vs MTA.

The authors concluded

The results from network meta-analyses showed that after 9–12 months, 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 18–24 months, formocresol, ferric sulfate, and MTA had significantly better clinical and radiographic outcomes than calcium hydroxide and laser therapies in primary molar pulpotomies.

Comment

This is an interesting review as it uses a network meta-analysis approach. This allows indirect comparisons of interventions. For example if there are only studies available of agents A v’s B and agents B v’s C this approach allow also allows you to compare A v’s C.   In the case of pulpotomies there have been previous reviews that have compared one agent versus another (See Dental Elf 5^th Dec 2012).  While the majority of the included studies have been published since 2000 and all but 7 describe themselves as randomised, few of them describe the randomisation method or allocation concealment and even fewer reported sample size and statistical power calculations.

Links

Lin PY, Chen HS, Wang YH, Tu YK. Primary molar pulpotomy: A systematic review and network meta-analysis. J Dent. 2014 Feb 7. pii: S0300-5712(14)00040-2. doi: 10.1016/j.jdent.2014.02.001. [Epub ahead of print] Review. PubMed PMID: 24513112.

Dental Elf – 5^th Dec 2012 – Mineral trioxide aggregate for endodontic treatment of primary molars

Dental Elf – 28th Jan 2013 -Which pulp dressing after pulpotomy in primary molars?