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Mineral trioxide aggregate likely to have a better success rate than calcium hydroxide in mature permanent teeth undergoing partial pulpotomy
JADA+ CONTENT
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
MINERAL TRIOXIDE AGGREGATE LIKELY TO HAVE A BETTER SUCCESS RATE THAN CALCIUM HYDROXIDE IN MATURE PERMANENT TEETH UNDERGOING PARTIAL PULPOTOMY
Taha NA, Khazali MA. Partial pulpotomy in mature permanent teeth with clinical signs indicative of irreversible pulpitis: a randomized clinical trial [published online ahead of print June 30, 2017]. J Endod. http://dx.doi.org/10.1016/j.joen.2017.03.033. Key words. Endodontics; general dentistry; calcium hydroxide; deep caries; mineral trioxide aggregate; partial pulpotomy; pulpitis; randomized clinical trial. Clinical relevance. Since one of the aims of any restorative procedure should be to preserve as much tooth structure and tooth vitality whenever possible, clinicians often perform pulpotomies in permanent mature teeth (PMT). Knowing which dental material helps achieve better outcomes is crucial when performing pulpotomies in PMT. Study summary. The researchers conducted a randomized clinical trial (RCT) to compare the outcomes of using mineral trioxide aggregate (MTA) and calcium hydroxide (CH) for pulpotomy in PMT with signs of irreversible pulpitis. They enrolled 50 participants* with diagnoses of deep caries and irreversible pulpitis.y After the researchers performed partial pulpotomies,z they assigned the participants to receive MTA§ or CH.{ Three participants who had received CH (13%) and 1 who had received MTA (3%) underwent endodontic treatment owing to immediate failure. After 2 years, the proportion of patients with successful treatment outcomes was 85% in the group that received MTA and 43% in the group that received CH.# That is, participants who received MTA were 1.9 times more likely to have a successful treatment outcome than those who received CH.** The researchers did not observe dentin
bridge formation in the radiographs or discoloration of the crowns. Strengths and limitations. This RCT had a low risk of bias, and its results are useful in supporting clinical decisions. We have no major concerns regarding the methods used by the researchers to allocate participants to the treatments, perform the procedures, and measure the outcomes. Almost all participants were accounted for in the analysis. The researchers found that participants who received MTA were more likely to have a successful partial pulpotomy treatment outcome than those who received CH. Unfortunately, the number of participants included in this study was small, which resulted in a nonprecise estimate of the benefit. Therefore, our confidence in this benefit is reduced. The length of follow-up enhances the applicability of this study; even though 2 years is not that long, it is long enough to be important to patients. In addition, the participants included in the study were likely to be similar to most candidates for partial pulpotomy, which makes this evidence even more useful for making clinical decisions. n http://dx.doi.org/10.1016/j.adaj.2017.07.014 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * 54% female; mean (standard deviation) age, 30 (10) years; 30% maxillary first molars and 30% mandibular first and second molars. y Caries in more than two-thirds of dentin and a history of severe spontaneous lingering pain that could be reproduced by cold testing. z The researchers prepared the cavity using a high-speed fissure bur under water coolant and excavated caries using a large slow-speed round bur. They amputated 2 to 3 millimeters of exposed pulpal tissue by using a round sterile high-speed bur, flushed the pulp with 2.5% sodium hypochlorite, and controlled the bleeding with a cotton pellet soaked in sodium hypochlorite. § 3 mm of ProRoot MTA, white (Dentsply), which was covered by an intermediate restorative material for 1 week. The tooth was restored with a layer of resin-modified glass ionomer liner and an amalgam or resin-based composite. { 3 mm of Dycal (Dentsply) caulk, which was covered by an intermediate restorative material for 1 week. The tooth was restored with a layer of resinmodified glass ionomer liner and amalgam or resin-based composite. # The researchers defined “success” as the lack of any clinical and radiographic signs of pathology, normal mobility, and pulp vitality. ** Risk ratio, 1.9; 95% confidence interval, 1.2 to 3.2.
JADA
( )
- -
http://jada.ada.org
-
2017 e1
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
MINERAL TRIOXIDE AGGREGATE LIKELY TO HAVE A BETTER SUCCESS RATE THAN CALCIUM HYDROXIDE IN MATURE PERMANENT TEETH UNDERGOING PARTIAL PULPOTOMY
Taha NA, Khazali MA. Partial pulpotomy in mature permanent teeth with clinical signs indicative of irreversible pulpitis: a randomized clinical trial [published online ahead of print June 30, 2017]. J Endod. http://dx.doi.org/10.1016/j.joen.2017.03.033. Key words. Endodontics; general dentistry; calcium hydroxide; deep caries; mineral trioxide aggregate; partial pulpotomy; pulpitis; randomized clinical trial. Clinical relevance. Since one of the aims of any restorative procedure should be to preserve as much tooth structure and tooth vitality whenever possible, clinicians often perform pulpotomies in permanent mature teeth (PMT). Knowing which dental material helps achieve better outcomes is crucial when performing pulpotomies in PMT. Study summary. The researchers conducted a randomized clinical trial (RCT) to compare the outcomes of using mineral trioxide aggregate (MTA) and calcium hydroxide (CH) for pulpotomy in PMT with signs of irreversible pulpitis. They enrolled 50 participants* with diagnoses of deep caries and irreversible pulpitis.y After the researchers performed partial pulpotomies,z they assigned the participants to receive MTA§ or CH.{ Three participants who had received CH (13%) and 1 who had received MTA (3%) underwent endodontic treatment owing to immediate failure. After 2 years, the proportion of patients with successful treatment outcomes was 85% in the group that received MTA and 43% in the group that received CH.# That is, participants who received MTA were 1.9 times more likely to have a successful treatment outcome than those who received CH.** The researchers did not observe dentin
bridge formation in the radiographs or discoloration of the crowns. Strengths and limitations. This RCT had a low risk of bias, and its results are useful in supporting clinical decisions. We have no major concerns regarding the methods used by the researchers to allocate participants to the treatments, perform the procedures, and measure the outcomes. Almost all participants were accounted for in the analysis. The researchers found that participants who received MTA were more likely to have a successful partial pulpotomy treatment outcome than those who received CH. Unfortunately, the number of participants included in this study was small, which resulted in a nonprecise estimate of the benefit. Therefore, our confidence in this benefit is reduced. The length of follow-up enhances the applicability of this study; even though 2 years is not that long, it is long enough to be important to patients. In addition, the participants included in the study were likely to be similar to most candidates for partial pulpotomy, which makes this evidence even more useful for making clinical decisions. n http://dx.doi.org/10.1016/j.adaj.2017.07.014 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * 54% female; mean (standard deviation) age, 30 (10) years; 30% maxillary first molars and 30% mandibular first and second molars. y Caries in more than two-thirds of dentin and a history of severe spontaneous lingering pain that could be reproduced by cold testing. z The researchers prepared the cavity using a high-speed fissure bur under water coolant and excavated caries using a large slow-speed round bur. They amputated 2 to 3 millimeters of exposed pulpal tissue by using a round sterile high-speed bur, flushed the pulp with 2.5% sodium hypochlorite, and controlled the bleeding with a cotton pellet soaked in sodium hypochlorite. § 3 mm of ProRoot MTA, white (Dentsply), which was covered by an intermediate restorative material for 1 week. The tooth was restored with a layer of resin-modified glass ionomer liner and an amalgam or resin-based composite. { 3 mm of Dycal (Dentsply) caulk, which was covered by an intermediate restorative material for 1 week. The tooth was restored with a layer of resinmodified glass ionomer liner and amalgam or resin-based composite. # The researchers defined “success” as the lack of any clinical and radiographic signs of pathology, normal mobility, and pulp vitality. ** Risk ratio, 1.9; 95% confidence interval, 1.2 to 3.2.
JADA
( )
- -
http://jada.ada.org
-
2017 e1