Summary of findings for the main comparison. Pulpotomy compared with pulpotomy using alternative medicament/technique for extensive decay in primary teeth.
| Pulpotomy compared with pulpotomy using alternative medicament/technique for extensive decay in primary teeth | ||||||
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Population: children with extensive decay in primary teeth Settings: primary care Intervention: pulpotomy with one type of medicament Comparison: pulpotomy using alternative medicament or different technique | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Experimental | |||||
| MTA versus formocresol | ||||||
|
Clinical failure (12 months) |
28 per 1000 | 8.6 per 1000 (2.8 per 1000 to 26.0 per 1000) | RR 0.31 (0.10 to 0.93) | 740 (12 studies) |
⊕⊕⊕⊝ moderate1 | Failure rate less than 3% across both the MTA and formocresol treatment groups. Seven of the 12 studies had no failures at 12 months. No evidence of a difference in clinical failure at 6 months or 24 months |
|
Radiological failure (12 months) |
50 per 1000 | 20.5 per 1000 (9.5 per 1000 to 44.5 per 1000) | RR 0.41 (0.19 to 0.89) | 740 (12 studies) | ⊕⊕⊕⊝ moderate1 | Failure rate 5% across formocresol treatment groups and 2.1% across MTA treatment groups. Five of the 12 studies had no failures at 12 months. Results similar at 6 and 24 months |
| MTA versus calcium hydroxide | ||||||
| Clinical failure (12 months) | 14 per 1000 | 2.2 per 1000 (0.02 per 1000 to 9.8 per 1000) | RR 0.16 (0.04 to 0.70) | 150 (4 studies) | ⊕⊕⊕⊝ moderate1 | Results similar at 24 months. No evidence of a difference in clinical failure at 6 months |
|
Radiological failure (12 months) |
351 per 1000 | 42.1 per 1000 (14 per 1000 to 126.4 per 1000) | RR 0.12 (0.04 to 0.36) | 150 (4 studies) | ⊕⊕⊝⊝ low2 | Results similar at 6 and 24 months |
| Calcium hydroxide versus formocresol | ||||||
| Clinical failure (12 months) | 115 per 1000 | 215 per 1000 (140.3 per 1000 to 332.4 per 1000) | RR 1.87 (1.22 to 2.89) | 332 (6 studies) | ⊕⊕⊕⊝ moderate1 | Results similar at 6 months No evidence of a difference in clinical failure at 24 months |
| Radiological failure (12 months) | 253 per 1000 | 470.6 per 1000 (359.3 per 1000 to 617.3 per 1000) | RR 1.86 (1.42 to 2.44) | 332 (6 studies) | ⊕⊕⊕⊝ moderate1 | Results similar at 6 and 24 months |
| Other comparisons assessed in more than one trial that had treatment failures | ||||||
| Clinical failure (at six, 12 and 24 months) | The quality of the evidence waslow for 4 comparisons3: laser versus ferric sulphate; Biodentine versus MTA; ferric sulphate versus formocresol; electrosurgery versus ferric sulphate; calcium hydroxide versus ferric sulphate. The quality of the evidence was very low for 5 comparisons: NaOCl versus ferric sulphate4; laser versus electrosurgery4; MTA versus ferric sulphate5; ABS versus ferric sulphate6; EMD versus formocresol7. |
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| Radiological failure (at six, 12 and 24 months) | The quality of the evidence waslow for 8 comparisons: NaOCl versus ferric sulphate2; MTA versus ferric sulphate3; Biodentine versus MTA3; ferric sulphate versus formocresol3; laser versus ferric sulphate3; electrosurgery versus ferric sulphate3; ABS versus ferric sulphate3; laser versus electrosurgery3; calcium hydroxide versus ferric sulphate (favouring ferric sulphate)3. | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1. Downgraded 1 level due to high risk of bias 2. Downgraded 1 level due to high risk of bias and 1 level due to substantial inconsistency 3. Downgraded 1 level due to high risk of bias and 1 level due to imprecision 4. Downgraded 1 level due to high risk of bias and 2 levels due to imprecision 5. Downgraded 1 level due to high risk of bias, 1 level due to moderate inconsistency and 1 level due to imprecision 6. Downgraded 1 level due to high risk of bias and 2 levels due to very serious imprecision 7. Downgraded 1 level due to high risk of bias, 1 level due to substantial inconsistency and 1 level due to imprecision