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. 2018 May 31;2018(5):CD003220. doi: 10.1002/14651858.CD003220.pub3

Fishman 1996.

Methods RCT, parallel‐arm
Teeth randomly assigned
Conducted in a hospital‐based (Long Beach Memorial Medical Center) dental clinic in California, USA (noted as predominantly children from low‐income families). Operators not mentioned
Participants 38 children, 47 teeth, mean age 5 years, age range 3.1 to 8.1 years
Interventions Group 1:Pulpotomy (ZOE); n = 24 (1 visit)
  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator or slow‐speed bur

  • For haemostasis, dry cotton pellet and electrofulguration. During the procedure, the active electrode tip was positioned slightly above the pulp tissue and close enough for electrical arcing to occur (about 1 mm above the tissue). A Hyfrecator was used in this study. The current was applied for 1‐2 seconds over each pulpal stump. If additional fulguration was required, 10 seconds elapsed prior to subsequent application of the current

  • No irrigation

  • ZOE after pulpotomy, then restored with stainless‐steel crowns


Group 2:Pulpotomy (calcium hydroxide); n = 23 (1 visit)
  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator or slow‐speed bur

  • For haemostasis, dry cotton pellet and electrofulguration. During the procedure, the active electrode tip was positioned slightly above the pulp tissue and close enough for electrical arcing to occur (about 1 mm above the tissue). A Hyfrecator was used in this study. The current was applied for 1‐2 seconds over each pulpal stumps. If additional fulguration was required, 10 seconds elapsed prior to subsequent application of the current

  • No irrigation

  • CH after pulpotomy, then restored with stainless‐steel crowns

Outcomes Clinical success (no excessive tooth mobility, no subjective symptoms of pain, no tenderness to percussion, and no fistula), radiographic success (normal periodontal ligament and absence of furcation or periapical radiolucency, internal or external resorption and calcific degeneration in the remaining pulp tissue), signs of failure (excessive tooth mobility, subjective symptoms of pain, tenderness to percussion, fistula, abnormal periodontal ligament, furcation or periapical radiolucency, internal or external resorption, and calcific degeneration in the remaining pulp tissue), periapical radiolucency, internal root resorption, external root resorption, periodontal ligament widening, pulp canal obliteration (parulis, fistula or swelling): evaluation at 1, 3 and 6 months (at tooth level)
Notes 47 teeth for treatment; 43 teeth from 35 children were available for evaluation after 6 months
1 month: 11 teeth in CH group and 10 teeth in ZOE group unavailable for recall; 3 months: 9 teeth in CH group and 8 teeth in ZOE group unavailable for recall; 6 months: 3 teeth in CH group and 1 tooth in ZOE group unavailable for recall 
Source of funding: not reported
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Insufficient information to make a clear judgement
Allocation concealment (selection bias) Low risk Numerical code which was available only to the operator
Blinding of participants and personnel (performance bias) 
 All outcomes Unclear risk Insufficient information to make a clear judgement
Blinding of clinical outcomes assessment Low risk Quote: "Clinical evaluation was determined by 2 examiners who had no knowledge if the experimental group of the tooth"
Blinding of radiological outcomes assessment Low risk Quote: "radiologic evaluation was determined by 2 examiners who had no knowledge if the experimental group of the tooth"
Incomplete outcome data (attrition bias) 
 All outcomes Low risk No missing data
Selective reporting (reporting bias) Unclear risk Insufficient information to make a clear judgement