Scolaris Content Display Scolaris Content Display

Tratamiento de la pulpa para el deterioro extenso de los dientes primarios

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References

References to studies included in this review

Aeinehchi 2007 {published data only}

Aeinehchi M, Dadvand S, Fayazi S, Bayat‐Movahed S. Randomized controlled trial of mineral trioxide aggregate and formocresol for pulpotomy in primary molar teeth. International Endodontic Journal2007; Vol. 40, issue 4:261‐7. CENTRAL

Agamy 2004 {published data only}

Agamy HA, Bakry NS, Mounir MM, Avery DR. Comparison of mineral trioxide aggregate and formocresol as pulp‐capping agents in pulpotomized primary teeth. Pediatric Dentistry2004; Vol. 26, issue 4:302‐9. CENTRAL

Akcay 2014 {published data only}

Akcay M, Sari S. The effect of sodium hypochlorite application on the success of calcium hydroxide and mineral trioxide aggregate pulpotomies in primary teeth. Pediatric Dentistry 2014;36(4):316‐21. CENTRAL

Alaçam 1989 {published and unpublished data}

Alaçam A. Long term effects of primary teeth pulpotomies with formocresol, glutaraldehyde‐calcium and glutaraldehyde‐zinc oxide eugenol on succudaneous teeth. Journal of Pedodontics 1989;13(4):307‐13. CENTRAL
Alaçam A. Pulpal tissue changes following pulpotomies with formocresol, glutaraldehyde‐calcium hydroxide, glutaraldehyde‐zinc oxide eugenol pastes in primary teeth. Journal of Pedodontics 1989;13:123‐32. CENTRAL

Alaçam 2009 {published data only}

Alaçam A, Odabaş ME, Tüzüner T, Sillelioğlu H, Baygin O. Clinical and radiographic outcomes of calcium hydroxide and formocresol pulpotomies performed by dental students. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 2009;108(5):e127‐33. CENTRAL

Al‐Ostwani 2016 {published data only}

Al‐Ostwani AO, Al‐Monaqel BM, Al‐Tinawi MK. A clinical and radiographic study of four different root canal fillings in primary molars. Journal of the Indian Society of Pedodontics and Preventive Dentistry 2016;34:55‐9. CENTRAL

Aminabadi 2010 {published data only}

Aminabadi NA, Farahani RM, Oskouei SG. Formocresol versus calcium hydroxide direct pulp capping of human primary molars: two year follow‐up. Journal of Clinical Pediatric Dentistry 2010;34(4):317‐21. [PUBMED: 20831133]CENTRAL

Aminabadi 2016 {published data only}

Asl Aminabadi N, Satrab S, Najafpour E, Samiei M, Jamali Z, Shirazi S. A randomized trial of direct pulp capping in primary molars using MTA compared to 3Mixtatin: a novel pulp capping biomaterial. International Journal of Paediatric Dentistry 2016;26(4):281‐90. CENTRAL

Ansari 2010 {published data only}

Ansari G, Ranjpour M. Mineral trioxide aggregate and formocresol pulpotomy of primary teeth: a 2‐year follow‐up. International Endodontic Journal 2010;43(5):413‐8. [PUBMED: 20518934]CENTRAL

Arikan 2016 {published data only}

Arikan V, Sonmez H, Sari S. Comparison of two base materials regarding their effect on root canal treatment success in primary molars with furcation lesions. BioMed Research International 2016;2016:1429286. CENTRAL

Bahrololoomi 2008 {published data only}

Bahrololoomi Z, Moeintaghavi A, Emtiazi M, Hosseini G. Clinical and radiographic comparison of primary molars after formocresol and electrosurgical pulpotomy: a randomized clinical trial. Indian Journal of Dental Research2008; Vol. 19, issue 3:219‐23. CENTRAL

Bezgin 2016 {published data only}

Bezgin T, Ozgul BM, Arikan V, Sari S. Root canal filling in primary molars without successors: Mineral trioxide aggregate versus gutta‐percha/AH‐Plus. Australian Endodontic Journal 2016;42:73‐81. CENTRAL

Cantekin 2014 {published data only}

Cantekin K, Gümüş H. Success rates of ankaferd blood stopper and ferric sulfate as pulpotomy agents in primary molars. International Scholarly Research Notices 2014;2014:819605. CENTRAL

Casas 2004 {published data only}

Casas MJ, Kenny DJ, Johnston DH, Judd PL. Long‐term outcomes of primary molar ferric sulfate pulpotomy and root canal therapy. Pediatric Dentistry 2004;26(1):44‐8. CENTRAL
Casas MJ, Layug MA, Kenny DJ, Johnston DH, Judd PL. Two‐year outcomes of primary molar ferric sulfate pulpotomy and root canal therapy. Pediatric Dentistry 2003;25(2):97‐102. [PUBMED: 12723832]CENTRAL

Celik 2013 {published data only}

Celik B, Ataç AS, Cehreli ZC, Uysal S. A randomized trial of mineral trioxide aggregate cements in primary tooth pulpotomies. Journal of Dentistry for Children (Chicago, Ill.) 2013;80(3):126‐32. CENTRAL

Chandra 2014 {published data only}

Chandra SP, Chandrasekhar R, Uloopi KS, Vinay C, Kumar NM. Success of root fillings with zinc oxide‐ozonated oil in primary molars: preliminary results. European Archives of Paediatric Dentistry 2014;15(3):191‐5. CENTRAL

Chen 2015 {published data only}

Chen XX, Lin BC, Zhong J, Ge LH. Degradation evaluation and success of pulpectomy with a modified primary root canal filling in primary molars. Beijing Da Xue Xue Bao Yi Xue Ban 2015;47(3):529‐35. CENTRAL

Coser 2008 {published data only}

Coser RM, Gondim JO, Aparecida Giro EM. Evaluation of 2 endodontic techniques used to treat human primary molars with furcation radiolucency area: a 48‐month radiographic study. Quintessence International 2008;39(7):549‐57. CENTRAL

Cuadros‐Fernández 2016 {published data only}

Cuadros‐Fernández C, Lorente Rodríguez AI, Sáez‐Martínez S, García‐Binimelis J, About I, Mercadé M. Short‐term treatment outcome of pulpotomies in primary molars using mineral trioxide aggregate and Biodentine: a randomized clinical trial. Clinical Oral Investigations 2016;20(7):1639‐45. CENTRAL

Dean 2002 {published and unpublished data}

Dean JA, Mack RB, Fulkerson BT, Sanders BJ. Comparison of electrosurgical and formocresol pulpotomy procedures on children. International Journal of Paediatric Dentistry 2002;12:177‐82. [MEDLINE: 22024492]CENTRAL

Demir 2007 {published data only}

Demir T, Cehreli ZC. Clinical and radiographic evaluation of adhesive pulp capping in primary molars following hemostasis with 1.25% sodium hypochlorite: 2‐year results. American Journal of Dentistry 2007;20(3):182‐8. CENTRAL

Doyle 2010 {published data only}

Doyle TL, Casas MJ, Kenny DJ, Judd PL. Mineral trioxide aggregate produces superior outcomes in vital primary molar pulpotomy. Pediatric Dentistry 2010;32(1):41‐7. [PUBMED: 20298652]CENTRAL

Durmus 2014 {published data only}

Durmus B, Tanboga I. In vivo evaluation of the treatment outcome of pulpotomy in primary molars using diode laser, formocresol, and ferric sulphate. Photomedicine and Laser Surgery 2014;32(5):289‐95. CENTRAL

Eidelman 2001 {published data only}

Eidelman E, Holan G, Fuks AB. Mineral trioxide aggregate vs. formocresol in pulpotomized primary molars: a preliminary report. Pediatric Dentistry 2001;23(1):15‐8. [MEDLINE: 21133329]CENTRAL

El Meligy 2016 {published data only}

El Meligy O A, Allazzam S, Alamoudi N M. Comparison between biodentine and formocresol for pulpotomy of primary teeth: A randomized clinical trial. Quintessence International 2016;47(7):571‐80. CENTRAL

Erdem 2011 {published data only}

Erdem AP, Guven Y, Balli B, Ilhan B, Sepet E, Ulukapi I, et al. Success rates of mineral trioxide aggregate, ferric sulfate, and formocresol pulpotomies: a 24‐month study. Pediatric Dentistry 2011;33(2):165‐70. [PUBMED: 21703067]CENTRAL

Fallahinejad Ghajari 2013 {published data only}

Fallahinejad Ghajari M, Asgharian Jeddi T, Iri S, Asgary S. Direct pulp‐capping with calcium enriched mixture in primary molar teeth: a randomized clinical trial. Iranian Endodontic Journal 2010;5(1):27‐30. CENTRAL
Fallahinejad Ghajari M, Asgharian Jeddi T, Iri S, Asgary S. Treatment outcomes of direct pulp‐capping after 20 months: a randomized controlled trial. Iranian Endodontic Journal 2013;8(4):149‐52. CENTRAL

Farsi 2005 {published data only}

Farsi N, Alamoudi N, Balto K, Mushayt A. Success of mineral trioxide aggregate in pulpotomized primary molars. Journal of Clinical Pediatric Dentistry 2005;29(4):307‐11. CENTRAL

Fei 1991 {published and unpublished data}

Fei AL, Udin RD, Johnson R. A clinical study of ferric sulfate as a pulpotomy agent in primary teeth. Pediatric Dentistry 1991;13(6):327‐32. [MEDLINE: 93181319]CENTRAL

Fernandes 2015 {published data only}

Fernandes A P, Lourenco Neto N, Teixeira Marques N C, Silveira Moretti A B, Sakai V T, Cruvinel Silva T, et al. Clinical and radiographic outcomes of the use of Low‐Level Laser Therapy in vital pulp of primary teeth. International Journal of Paediatric Dentistry 2015;25(2):144‐50. CENTRAL

Fernández 2013 {published data only}

Fernández CC, Martínez SS, Jimeno FG, Lorente Rodríguez AI, Mercadé M. Clinical and radiographic outcomes of the use of four dressing materials in pulpotomized primary molars: a randomized clinical trial with 2‐year follow‐up. International Journal of Paediatric Dentistry 2013;23(6):400‐7. CENTRAL

Fishman 1996 {published data only}

Fishman SA, Udin RD, Good DL, Rodef F. Success of electrofulguration pulpotomies covered by zinc oxide and eugenol or calcium hydroxide: a clinical study. Pediatric Dentistry 1996;18(5):385‐90. [MEDLINE: 97052902]CENTRAL

Fuks 1997 {published and unpublished data}

Fuks AB, Holan G, Davis JM, Eidelman E. Ferric sulfate versus dilute formocresol in pulpotomized primary molars: long‐term follow up. Pediatric Dentistry 1997;19(5):327‐30. CENTRAL

Garrocho‐Rangel 2009 {published data only}

Garrocho‐Rangel A, Flores H, Silva‐Herzog D, Hernandez‐Sierra F, Mandeville P, Pozos‐Guillen AJ. Efficacy of EMD versus calcium hydroxide in direct pulp capping of primary molars: a randomized controlled clinical trial. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 2009;107(5):733‐8. CENTRAL

Goyal 2014 {published data only}

Goyal S, Abuwala T, Joshi K, Mehta J, Indushekar KR, Hallikerimath S. The clinical, radiographic and histological evaluation of three different concentrations of formocresol as a pulpotomy agent. Journal of International Oral Health 2014;6(2):118‐25. CENTRAL

Goyal 2016 {published data only}

Goyal P, Pandit IK, Gugnani N, Gupta M, Goel R, Gambhir RS. Clinical and radiographic comparison of various medicaments used for pulpotomy in primary molars: A randomized clinical trial. European Journal of Dentistry 2016;10(3):315‐20. [PUBMED: 27403046]CENTRAL

Grewal 2016 {published data only}

Grewal N, Salhan R, Kaur N, Patel H B. Comparative evaluation of calcium silicate‐based dentin substitute (Biodentine(R)) and calcium hydroxide (pulpdent) in the formation of reactive dentin bridge in regenerative pulpotomy of vital primary teeth: Triple blind, randomized clinical trial. Contemporary Clinical Dentistry 2016;7(4):457‐63. CENTRAL

Gupta 2015 {published data only}

Gupta G, Rana V, Srivastava N, Chandna P. Laser Pulpotomy‐An Effective Alternative to Conventional Techniques: A 12 Months Clinicoradiographic Study. Jaypees International Journal of Clinical Pediatric Dentistry 2015;8(1):18‐21. CENTRAL

Haghgoo 2009 {published data only}

Haghgoo R, MollaAsadolla F, Abbasi F. Evaluation of clinical and radiographic success rates of root MTA and formocresol in pulpotomy of primary molars. Journal of Dental Medicine 2009;22(2):136‐41. CENTRAL

Holan 2005 {published data only}

Holan G, Eidelman E, Fuks AB. Long‐term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol. Pediatric Dentistry2005; Vol. 27, issue 2:129‐36. CENTRAL

Huth 2005 {published data only}

Huth KC, Paschos E, Hajek‐Al‐Khatar N, Hollweck R, Crispin A, Hickel R, et al. Effectiveness of 4 pulpotomy techniques ‐ randomized controlled trial. Journal of Dental Research 2005;84(12):1144‐8. CENTRAL

Ibricevic 2000 {published and unpublished data}

Ibricevic H, Al‐Jame Q. Ferric sulfate as pulpotomy agent in primary teeth: twenty month clinical follow‐up. Journal of Clinical Pediatric Dentistry 2000;24(4):269‐72. [MEDLINE: 21210539]CENTRAL
Ibricevic H, Al‐Jame Q. Ferric sulphate and formocresol in pulpotomy of primary molars: long term follow‐up study. European Journal of Paediatric Dentistry 2003;4(1):28‐32. [PUBMED: 12870985]CENTRAL

Jayam 2014 {published data only}

Jayam C, Mitra M, Mishra J, Bhattacharya B, Jana B. Evaluation and comparison of white mineral trioxide aggregate and formocresol medicaments in primary tooth pulpotomy: clinical and radiographic study. Journal of Indian Society of Pedodontics and Preventive Dentistry 2014;32(1):13‐8. CENTRAL

Kalra 2017 {published data only}

Kalra M, Garg N, Rallan M, Pathivada L, Yeluri R. Comparative evaluation of fresh aloe barbadensis plant extract and mineral trioxide aggregate as pulpotomy agents in primary molars: a 12‐month follow‐up study. Contemporary Clinical Dentistry 2017;8(1):106‐11. CENTRAL

Kang 2015 {published data only}

Kang C‐M, Kim S‐H, Shin Y, Lee H‐S, Lee J‐H, Kim GT, et al. A randomized controlled trial of ProRoot MTA, Ortho MTA and Retro MTA for pulpotomy in primary molars. Oral Diseases 2015;21(6):785‐91. CENTRAL

Khorakian 2014 {published data only}

Khorakian F, Mazhari F, Asgary S, Sahebnasagh M, Alizadeh Kaseb A, Movahhed T, et al. Two‐year outcomes of electrosurgery and calcium‐enriched mixture pulpotomy in primary teeth: a randomised clinical trial. European Archives of Paediatric Dentistry 2014;15(4):223‐8. CENTRAL

Kusum 2015 {published data only}

Kusum B, Rakesh K, Richa K. Clinical and radiographical evaluation of mineral trioxide aggregate, biodentine and propolis as pulpotomy medicaments in primary teeth. Restorative Dentistry and Endodontics 2015;40(4):276‐85. CENTRAL

Liu 2011 {published data only}

Liu H, Zhou Q, Qin M. Mineral trioxide aggregate versus calcium hydroxide for pulpotomy in primary molars. Chinese Journal of Dental Research 2011;14(2):121‐5. CENTRAL

Lourenço 2015a {published data only}

Lourenço Neto N, Marques NC, Fernandes AP, Hungaro Duarte MA, Abdo RC, Machado MA, et al. Clinical and radiographic evaluation of Portland cement added to radiopacifying agents in primary molar pulpotomies. European Archives of Paediatric Dentistry 2015;16(5):377‐82. [PUBMED: 25788172]CENTRAL

Malekafzali 2011 {published data only}

Malekafzali B, Shekarchi F, Asgary S. Treatment outcomes of pulpotomy in primary molars using two endodontic biomaterials. A 2‐year randomised clinical trial. European Journal of Paediatric Dentistry 2011;12(3):189‐93. [PUBMED: 22077689]CENTRAL

Markovic 2005 {published data only}

Markovic D, Zivojinovic V, Vucetic M. Evaluation of three pulpotomy medicaments in primary teeth. European Journal of Paediatric Dentistry2005; Vol. 6, issue 3:133‐8. CENTRAL

Moretti 2008 {published data only}

Moretti AB, Sakai VT, Oliveira TM, Fornetti AP, Santos CF, Machado MA, et al. The effectiveness of mineral trioxide aggregate, calcium hydroxide and formocresol for pulpotomies in primary teeth. International Endodontic Journal2008; Vol. 41, issue 7:547‐55. CENTRAL

Mortazavi 2004 {published data only}

Mortazavi M, Mesbahi M. Comparison of zinc oxide and eugenol, and Vitapex for root canal treatment of necrotic primary teeth. International Journal of Paediatric Dentistry2004; Vol. 14, issue 6:417‐24. CENTRAL

Nadkarni 2000 {published data only}

Nadkarni U, Damle SG. Comparative evaluation of calcium hydroxide and zinc oxide eugenol as root canal filling materials for primary molars: a clinical and radiographic study. Journal of the Indian Society of Pedodontics and Preventive Dentistry 2000;18(1):1‐10. [MEDLINE: 21222096]CENTRAL

Naik 2005 {published data only}

Naik S, Hegde AH. Mineral trioxide aggregate as a pulpotomy agent in primary molars: an in vivo study. Journal of the Indian Society of Pedodontics and Preventive Dentistry 2005;23(1):13‐6. [PUBMED: 15858300]CENTRAL

Nakornchai 2010 {published data only}

Nakornchai S, Banditsing P, Visetratana N. Clinical evaluation of 3Mix and Vitapex as treatment options for pulpally involved primary molars. International Journal of Paediatric Dentistry 2010;20(3):214‐21. [PUBMED: 20409203]CENTRAL

Nguyen 2017 {published data only}

Nguyen T D, Judd P L, Barrett E J, Sidhu N, Casas M J. Comparison of ferric sulfate combined mineral trioxide aggregate pulpotomy and zinc oxide eugenol pulpectomy of primary maxillary incisors: an 18‐month randomized, controlled trial. Pediatric Dentistry 2017;39(1):34‐8. CENTRAL

Niranjani 2015 {published data only}

Niranjani K, Prasad MG, Vasa AA, Divya G, Thakur MS, Saujanya K. Clinical evaluation of success of primary teeth pulpotomy using Mineral Trioxide Aggregate(®), laser and Biodentine(TM)‐ an in vivo study. Journal of Clinical and Diagnostic Research 2015;9(4):ZC35‐7. CENTRAL

Noorollahian 2008 {published data only}

Noorollahian H. Comparison of mineral trioxide aggregate and formocresol as pulp medicaments for pulpotomies in primary molars. British Dental Journal2008; Vol. 204, issue 11:E20. CENTRAL

Olatosi 2015 {published data only}

Olatosi OO, Sote EO, Orenuga OO. Effect of mineral trioxide aggregate and formocresol pulpotomy on vital primary teeth: a clinical and radiographic study. Nigerian Journal of Clinical Practice 2015;18(2):292‐6. CENTRAL

Oliveira 2013a {published data only}

Oliveira TM, Moretti AB, Sakai VT, Lourenço Neto N, Santos CF, Machado MA, et al. Clinical, radiographic and histologic analysis of the effects of pulp capping materials used in pulpotomies of human primary teeth. European Archives of Paediatric Dentistry 2013;14(2):65‐71. [PUBMED: 23549993]CENTRAL

Ozalp 2005 {published data only}

Ozalp N, Saroğlu I, Sönmez H. Evaluation of various root canal filling materials in primary molar pulpectomies: an in vivo study. American Journal of Dentistry2005; Vol. 18, issue 6:347‐50. CENTRAL

Ozmen 2017 {published data only}

Ozmen B, Bayrak S. Comparative evaluation of ankaferd blood stopper, ferric sulfate, and formocresol as pulpotomy agent in primary teeth: A clinical study. Nigerian Journal of Clinical Practice 2017;20(7):832‐8. CENTRAL

Pinky 2011 {published data only}

Pinky C, Shashibhushan KK, Subbareddy VV. Endodontic treatment of necrosed primary teeth using two different combinations of antibacterial drugs: an in vivo study. Journal of the Indian Society of Pedodontics and Preventive Dentistry 2011;29(2):121‐7. [PUBMED: 21911950]CENTRAL

Prabhakar 2008 {published data only}

Prabhakar AR, Sridevi E, Raju OS, Satish V. Endodontic treatment of primary teeth using combination of antibacterial drugs: an in vivo study. Journal of the Indian Society of Pedodontics and Preventive Dentistry 2008;26(5):5‐10. CENTRAL

Pramila 2016 {published data only}

Pramila R, Muthu M S, Deepa G, Farzan J M, Rodrigues S J. Pulpectomies in primary mandibular molars: a comparison of outcomes using three root filling materials. International Endodontic Journal 2016;49(5):413‐21. CENTRAL

Rajasekharan 2017 {published data only}

Rajasekharan S, Martens L C, Vandenbulcke J, Jacquet W, Bottenberg P, Cauwels R G. Efficacy of three different pulpotomy agents in primary molars: a randomized control trial. International Endodontic Journal 2017;50(3):215‐28. CENTRAL

Ramar 2010 {published data only}

Ramar K, Mungara J. Clinical and radiographic evaluation of pulpectomies using three root canal filling materials: an in‐vivo study. Journal of the Indian Society of Pedodontics and Preventive Dentistry 2010;28(1):25‐9. [PUBMED: 20215668]CENTRAL

Rewal 2014 {published data only}

Rewal N, Thakur A S, Sachdev V, Mahajan N. Comparison of endoflas and zinc oxide eugenol as root canal filling materials in primary dentition. Journal of Indian Society of Pedodontics and Preventive Dentistry 2014;32(4):317‐21. CENTRAL

Sabbarini 2008 {published data only}

Sabbarini J, Mohamed A, Wahba N, El‐Meligy O, Dean J. Comparison of enamel matrix derivative versus formocresol as pulpotomy agents in the primary dentition. Journal of Endodontics2008; Vol. 34, issue 3:284‐7. CENTRAL

Sakai 2009 {published data only}

Sakai VT, Moretti ABS, Oliveira TM, Fornetti APC, Santos CF, Machado M, et al. Summary of pulpotomy of human primary molars with MTA and Portland cement: a randomised controlled trial. British Dental Journal 2009;207(3):128‐9. [0007‐0610]CENTRAL

Saltzman 2005 {published data only}

Saltzman B, Sigal M, Clokie C, Rukavina J, Titley K, Kulkarni GV. Assessment of a novel alternative to conventional formocresol‐zinc oxide eugenol pulpotomy for the treatment of pulpally involved human primary teeth: diode laser‐mineral trioxide aggregate pulpotomy. International Journal of Paediatric Dentistry2005; Vol. 15, issue 6:437‐47. CENTRAL

Shabzendedar 2013 {published data only}

Shabzendedar M, Mazhari F, Alami M, Talebi M. Sodium hypochlorite vs formocresol as pulpotomy medicaments in primary molars: 1‐year follow‐up. Pediatric Dentistry 2013;35(4):329‐32. CENTRAL

Shumayrikh 1999 {published and unpublished data}

Shumayrikh NM, Adenubi JO. Clinical evaluation of glutaraldehyde with calcium hydroxide and glutaraldehyde with zinc oxide eugenol in pulpotomy of primary molars. Endodontics and Dental Traumatology 1999;15(6):259‐64. [MEDLINE: 20285582]CENTRAL

Sonmez 2008 {published data only}

Sonmez D, Sari S, Cetinbaş T. A comparison of four pulpotomy techniques in primary molars: a long‐term follow‐up. Journal of Endodontics 2008;34(8):950‐5. CENTRAL

Subramaniam 2009 {published data only}

Subramaniam P, Konde S, Mathew S, Sugnani S. Mineral trioxide aggregate as pulp capping agent for primary teeth pulpotomy: 2 year follow up study. Journal of Clinical Pediatric Dentistry2009; Vol. 33, issue 4:311‐4. CENTRAL

Subramaniam 2011 {published data only}

Subramaniam P, Gilhotra K. Endoflas, zinc oxide eugenol and Metapex as root canal filling materials in primary molars ‐ a comparative clinical study. Journal of Clinical Pediatric Dentistry 2011;35(4):365‐9. [PUBMED: 22046693]CENTRAL

Trairatvorakul 2008 {published data only}

Trairatvorakul C, Chunlasikaiwan S. Success of pulpectomy with zinc oxide‐eugenol vs calcium hydroxide/iodoform paste in primary molars: a clinical study. Pediatric Dentistry2008; Vol. 30, issue 4:303‐8. CENTRAL

Tuna 2008 {published data only}

Tuna D, Olmez A. Clinical long‐term evaluation of MTA as a direct pulp capping material in primary teeth. International Endodontic Journal2008; Vol. 41, issue 4:273‐8. CENTRAL

Uloopi 2016 {published data only}

Uloopi KS, Vinay C, Ratnaditya A, Gopal AS, Mrudula KJ, Rao RC. Clinical evaluation of low level diode laser application for primary teeth pulpotomy. Journal of Clinical and Diagnostic Research 2016;10(1):ZC67‐70. CENTRAL

Ulusoy 2014a {published data only}

Ulusoy AT, Bayrak S, Bodrumlu EH. Clinical and radiological evaluation of calcium sulfate as direct pulp capping material in primary teeth. European Journal of Paediatric Dentistry 2014;15(2):127‐31. [PUBMED: 25102461]CENTRAL

Vargas 2006 {published data only}

Vargas KG, Packham B, Lowman D. Preliminary evaluation of sodium hypochlorite for pulpotomies in primary molars. Pediatric Dentistry2006; Vol. 28, issue 6:511‐7. CENTRAL

Waterhouse 2000 {published and unpublished data}

Waterhouse PJ, Nunn JH, Whitworth JM. An investigation of the relative efficacy of Buckley's formocresol and calcium hydroxide in primary molar vital pulp therapy. British Dental Journal 2000;188(1):32‐6. [MEDLINE: 20162444]CENTRAL
Waterhouse PJ, Nunn JH, Whitworth JM. Prostaglandin E2 and treatment outcome in pulp therapy of primary molars with carious exposures. International Journal of Paediatric Dentistry 2002;12(2):116‐23. [PUBMED: 11966889]CENTRAL

Yadav 2014 {published data only}

Yadav P, Indushekar K, Saraf B, Sheoran N, Sardana D. Comparative evaluation of Ferric Sulfate, Electrosurgical and Diode Laser on human primary molars pulpotomy: an "in‐vivo" study. Laser Therapy 2014;23(1):41‐7. CENTRAL

Yildirim 2016 {published data only}

Yildirim C, Basak F, Akgun OM, Polat GG, Altun C. Clinical and radiographic evaluation of the effectiveness of formocresol, mineral trioxide aggregate, portland cement, and enamel matrix derivative in primary teeth pulpotomies: a two year follow‐Up. Journal of Clinical Pediatric Dentistry 2016;40(1):14‐20. CENTRAL

Zealand 2010 {published data only}

Zealand CM, Briskie DM, Botero TM, Boynton JR, Hu JC. Comparing gray mineral trioxide aggregate and diluted formocresol in pulpotomized human primary molars. Pediatric Dentistry 2010;32(5):393‐9. [PUBMED: 21070705]CENTRAL

Zurn 2008 {published data only}

Zurn D, Seale NS. Light‐cured calcium hydroxide vs formocresol in human primary molar pulpotomies: a randomized controlled trial. Pediatric Dentistry2008; Vol. 30, issue 1:34‐41. CENTRAL

References to studies excluded from this review

Abdel‐Aziz 1999 {published data only}

Abdel‐Aziz A, Abdella A. Clinical and histological evaluation of three antiseptics used in abscessed primary molars. Pediatric Dentistry 1999;21(5):115. CENTRAL

Aktoren 2000 {published and unpublished data}

Aktoren O, Gencay K. A two year clinical‐radiographic follow‐up of the pulpotomies in primary molars. Journal of Dental Research 2000;79:543 (Abs No 3193). CENTRAL

Ansari 2009 {published and unpublished data}

Ansari G, Vahid Golpaygani M, Chitsazan I, Fekrazad R. Clinical and radiographic evaluation of diode laser pulpotomy on human primary teeth: a preliminary study. Lasers in Medical Science Conference: World Federation for Laser Dentistry (WFLD). Hong Kong, 2009; Vol. 24(3):470‐1. CENTRAL

Ayrton 1969 {published data only}

Ayrton Ode T, Benfatti SV, Andrioni JN. Clinical and morphological study of a therapeutic agent with formaldehyde base for the preservation of the deciduous teeth [Estudio clínico y morfológico de un medicamento con base de formaldehida para la conservación de los dientes temporales]. El Cooperador Dental; Cooperativismo, Información y Ciencia Odontológica 1969;35(1):16‐21. [PUBMED: 5255812]CENTRAL

Badzian‐Kobos 1967 {published data only}

Badzian‐Kobos K, Walczak A. Clinical evaluation of the results of treatment of live dental pulp with Ledermix and Calxyl in some pulp diseases in children [Kliniczna ocena wynikow leczenia przyzyciowego niektorych stanow chorobowych miazgi zebow dzieciecych preparatami "Ledermix" i "Calxyl"]. Czasopismo Stomatologiczne 1967;20(11):1139‐43. [PUBMED: 4965461]CENTRAL

Barcelos 2011 {published data only}

Barcelos R, Tannure PN, Rosario YMRV, Luiz RR, Gleiser R, Primo L. Permanent successors effects after smear layer removal in deciduous pulpectomies [abstract]. Proceedings of the 89th General Session of the International Association for Dental Research; 2011, Mar 16‐19; San Diego, California, United States. 2011:Abstract no: 3144. CENTRAL

Beaver 1966 {published data only}

Beaver HA, Kopel HM, Sabes WR. The effect of zinc oxide ‐ eugenol cement on a formocresolized pulp. Journal of Dentistry for Children 1966;33:381‐96. [MEDLINE: 1967042791]CENTRAL

Berrebi 2009 {published and unpublished data}

Berrebi J, Heysselaer D, Nyssen‐Behets C, Rocca JP, Mahler P, Limme M, et al. Clinical treatment of exposed pulp by direct capping/pulpotomy on primary and permanent immature teeth. Lasers in Medical Science Conference: World Federation for Laser Dentistry (WFLD). Hong Kong, 2009; Vol. 24(3):472. CENTRAL

Boggs 1969 {published data only}

Boggs DC. Simple technique for treating non‐vital deciduous teeth ‐ a study. Northwest Dentistry 1969;48(2):102‐4. [PUBMED: 5253110]CENTRAL

Brannstrom 1979 {published data only}

Brannstrom M, Nyborg H, Stromberg T. Experiments with pulp capping. Oral Surgery, Oral Medicine, and Oral Pathology 1979;48(4):347‐52. [PUBMED: 291861]CENTRAL

Casas 2003 {published data only}

Casas M, Kenny D, Johnston D, Judd P, Layug M. Three‐year prospective outcome study of ferric sulphate pulpotomies and root canal treatment in vital primary molars. International Journal of Paediatric Dentistry 2003;13 Suppl 1:9. CENTRAL

Chien 2001 {published data only}

Chien MM, Setzer S, Cleaton‐Jones P. How does zinc oxide‐eugenol compare to ferric sulphate as a pulpotomy material?. Journal of the South African Dental Association 2001;56(3):130‐5. [CN‐00567178]CENTRAL

Cuisia 2001 {published data only}

Cuisia ZE, Musselman R, Schneider P, Dummett C. A study of mineral trioxide aggregate pulpotomies in primary molars. Pediatric Dentistry 2001;23(2):168. CENTRAL

Damle 1999 {published data only}

Damle SG, Nadkarni U. A comparative study of two root canal resorbable filling materials in primary molars. International Journal of Paediatric Dentistry 1999;9 Suppl 1:86 (Abs No 35.03). CENTRAL

Droter 1967 {published data only}

Droter JA. Pulp therapy in primary teeth. Journal of Dentistry for Children 1967;34(6):507‐10. [PUBMED: 4864184]CENTRAL

Einwag 1991 {published data only}

Einwag J. Endodontics in primary dentition [Endodontie im milchgebiss]. Zahnarztliche Mitteilungen 1991;81(9):878‐84. [PUBMED: 1906661]CENTRAL

Elomaa 1974 {published data only}

Elomaa M, Rantanen L, Nystrom M. Use of chemotherapeutic‐corticoid combination in vital pulpotomy. Proceedings of the Finnish Dental Society. Suomen Hammaslaakariseuran Toimituksia 1974;70(1):1‐6. [PUBMED: 4821944]CENTRAL

Fuks 2000 {published data only}

Fuks AB, Papagiannoulis L, Geki S, Koulatzidou M, Polychronopoulou A. One‐year comparative study in pulpotomized primary teeth using ferric sulfate and diluted formocresol. European Journal of Paediatric Dentistry 2000;1(3):128 (Abs No 98). CENTRAL

Grivu 1966 {published data only}

Grivu O, Mecher E, Stoica E. Principles and present status of the therapy of pulp diseases in children [Principiile si stadiul actual al terapiei pulpopatiilor la copii]. Stomatologia 1966;13(3):233‐44. [PUBMED: 5224151]CENTRAL

Hannah 1972 {published data only}

Hannah DR. Glutaraldehyde and calcium hydroxide. A pulp dressing material. British Dental Journal 1972;132(6):227‐31. [PUBMED: 4504039]CENTRAL

Hansen 1971 {published data only}

Hansen HP, Ravn JJ, Ulrich D. Vital pulpotomy in primary molars. A clinical and histologic investigation of the effect of zinc oxide‐eugenol cement and Ledermix. Scandinavian Journal of Dental Research 1971;79:13‐23. CENTRAL

Hartsook 1966 {published data only}

Hartsook JT. Pulpal therapy in primary and young permanent teeth. Dental Clinics of North America1966:377‐89. [PUBMED: 4222772]CENTRAL

Ibricevic 2001 {published and unpublished data}

Ibricevic H, Al‐Jame G. Ferric sulfate as pulpotomy agent in primary teeth: clinical study. Journal of Dental Research 2001;80(4):1216 (Abs No 123). CENTRAL

Kalaskar 2004 {published data only}

Kalaskar RR, Damle SG. Comparative evaluation of lyophilized freeze dried platelet derived preparation with calcium hydroxide as pulpotomy agents in primary molars. Journal of the Indian Society of Pedodontics and Preventive Dentistry 2004;22(1):24‐9. CENTRAL

Keszler 1987 {published data only}

Keszler A, Dominguez FV. Current status of pulp treatment with formocresol [Estado actual del tratamiento pulpar con formocresol]. Revista Española de Endodoncia 1987;5(2):63‐70. [PUBMED: 3483227]CENTRAL

Kouri 1969 {published data only}

Kouri EM, Matthews JL, Taylor PP. Epinephrine in pulpotomy. ASDC Journal of Dentistry for Children 1969;36(2):123‐8. [PUBMED: 4888301]CENTRAL

Liu 2003 {published and unpublished data}

Liu JF. Nd:YAG laser pulpotomy of human primary teeth. Lasers in Dentistry, Proceedings: Revolution of Dental Treatment in the New Millennium2003:251‐6. CENTRAL

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Liu JF. Effects of Nd:YAG laser pulpotomy on human primary molars. Journal of Endodontics2006; Vol. 32, issue 5:404‐7. CENTRAL

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Lourenço Neto N, Marques NC, Fernandes AP, Hungaro Duarte MA, Abdo RC, Machado MA, et al. Clinical and radiographic evaluation of Portland cement added to radiopacifying agents in primary molar pulpotomies. European Archives of Paediatric Dentistry 2015;16(5):377‐82. CENTRAL

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Louwakul P, Prucksathamrongkul W. Effect of chlorhexidine on outcome of pulpectomy in primary molars [abstract]. Proceedings of the 45th Meeting of the Continental European Division of the International Association of Dental Research; 2011, Aug 31‐Sep 3; Budapest, Hungary. 2011:Abstract no: 497. CENTRAL

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Mani SA, Chawla HS, Goel A. Zinc oxide‐eugenol or calcium hydroxide as root canal filling material in primary teeth. International Journal of Paediatric Dentistry 1999;9(Suppl 1):113. CENTRAL

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Mejare I. Pulpotomy of primary molars with coronal or total pulpitis using formocresol technique. Scandinavian Journal of Dental Research 1979;87(3):208‐16. CENTRAL

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NCT01622153. Electrical and formocresol pulpotomy in primary molars. Available from www.clinicaltrials.gov/ct2/show/record/NCT01622153 (accessed 22 November 2017). CENTRAL

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Odabas ME, Bodur H, Baris E, Demir C. Clinical, radiographic, and histopathologic evaluation of Nd:YAG laser pulpotomy on human primary teeth. Journal of Endodontics2007; Vol. 33, issue 4:415‐21. CENTRAL

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Percinoto C, de Castro AM, Pinto LM. Clinical and radiographic evaluation of pulpotomies employing calcium hydroxide and trioxide mineral aggregate. General Dentistry 2006;54(4):258‐61. [PUBMED: 16903198]CENTRAL

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Punwani I, Fadavi S. The efficacy of pulpfixÆ glutaraldehyde pulpotomy agent for the treatment of vital primary teeth with carious pulp exposure. Journal of Dental Research 1993;72:212 (IADR Abs No 869). CENTRAL

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Ram D, Moskovitz M, Fuks AB. Ferric sulfate versus formocresol in pulpotomized primary molars: clinical and radiographic results. Journal of Dental Research 2001;80:1311 (Abs No 20). CENTRAL

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Ravn JJ, Svarrer M. A clinicoradiographic follow‐up study of coronal vital pulpotomy in 200 primary molars treated with zinc‐oxide‐eugenol paste [En klinisk‐radiologisk efterundersogelse af koronal vitalamputation i 200 primaere molarer, behandlet med zinkilte‐euge‐nol som amputationspasta]. Tandlaegebladet 1968;72(8):718‐26. [PUBMED: 5247171]CENTRAL

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Reddy VVS, Fernandes. Clinical and radiological evaluation of zinc oxide‐eugenol and Maisto's paste as obturating materials in infected primary teeth ‐ nine months study. Journal of the Indian Society of Pedodontics and Preventive Dentistry 1996;14(2):39‐44. CENTRAL

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Redig DF. A comparison and evaluation of two formocresol pulpotomy technics utilizing "Buckley's" formocresol. Journal of Dentistry for Children 1968;35:22‐30. [MEDLINE: 68099489]CENTRAL

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Riccioli GA. Conservative therapy of the deciduous teeth [A proposito di terapie conservatrice dei decidui]. Mondo Odontostomatologico 1971;14(1):65‐7. [PUBMED: 5317205]CENTRAL

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Ripa LW. Pulp therapy in live deciduous teeth [Terapeutica pulpar para dientes temporales vivos]. Fauchard 1971;2(6):114‐7. [PUBMED: 5288029]CENTRAL

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Ritwik P, Cuisia ZV, Dabir P, Musselman RJ. MTA pulpotomies in the primary molars of children: results after 3 years. International Journal of Paediatric Dentistry 2003;13(Suppl 1):11. CENTRAL

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Rivera N, Reyes E, Mazzaoui S, Moron A. Pulpal therapy for primary teeth: formocresol vs electrosurgery: a clinical study. Journal of Dentistry for Children 2003;70(1):71‐3. [PUBMED: 12762614]CENTRAL

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Rocha M, Baroni R, Santos L, Girardi K. Calcium hydroxide and MTA pulpotomies in primary teeth: one year results. International Journal of Paediatric Dentistry 1999;9(Suppl 1):102. CENTRAL

Rule 1966 {published data only}

Rule DC, Winter GB. Root growth and apical repair subsequent to pulpal necrosis in children. British Dental Journal 1966;120(12):586‐90. [PUBMED: 5221182]CENTRAL

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Sargenti A. Rational root therapy of deciduous teeth with N2 [Die rationelle Wurzelbehandlung der Milchzahne mit N2]. Zahnarztliche Praxis 1975;26(9):198‐200. [PUBMED: 1057341]CENTRAL

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Sayegh FS, Reed AJ. Correlated clinical and histological evaluation of Hydrex in pulp therapy. Journal of Dentistry for Children 1967;34(6):471‐7. [PUBMED: 4864180]CENTRAL

Sogbe de Agell 1989 {published data only}

Sogbe de Agell R. Clinical and radiographic evaluation of deciduous molars with necrotic pulp treated with two concentrations of formocresol. Acta Odontológica Venezolana 1989;27(1):3‐9. [MEDLINE: 90328016]CENTRAL

Szabo 1968 {published data only}

Szabo H, Beczner S, Matavovszky M. Dental pulp treatment with "N2" material in deciduous molars [Tejmolarisok pulpakezelese "N2" anayaggal]. Fogorvosi Szemle 1968;61(12):268‐70. [PUBMED: 5251838]CENTRAL

Tsai 1993 {published and unpublished data}

Tsai TP, Su HL, Tseng LH. Glutaraldehyde preparations and pulpotomy in primary molars. Oral Surgery, Oral Medicine, and Oral Pathology 1993;76(3):346‐50. [MEDLINE: 93390905]CENTRAL

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Velkova A. Treatment of pulpitis in deciduous molars [Prispevek k problematice leceni docasnych pulpitickych molaru]. Ceskoslovenska Stomatologie 1977;77(4):277‐81. [PUBMED: 269022]CENTRAL

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Yakushiji M, Sasamoto K, Imanishi T, Machida Y, Sekine N. Clinical study of vital pulpotomy with Calvital on deciduous teeth. Shikwa Gakuho 1969;69(2):271‐5. [MEDLINE: 69190391]CENTRAL

Yildiz 2014 {published data only}

Yildiz E, Tosun G. Evaluation of formocresol, calcium hydroxide, ferric sulfate, and MTA primary molar pulpotomies. European Journal of Dentistry 2014;8(2):234‐40. CENTRAL

CTRI/2011/06/001776 {published data only}

CTRI/2011/06/001776. Root canal treatment in milk teeth using three root canal filling materials: a double‐blinded randomized controlled trial. Available from www.ctri.nic.in (accessed 28 November 2017). CENTRAL

NCT00802256 {published data only}

Comparative evaluation of pulpotomized primary molars with mineral trioxide aggregate and new endodontic cement. Available from www.clinicaltrials.gov/ct2/show/record/NCT00802256 (accessed 26 June 2017). CENTRAL

NCT00972556 {published data only}

Comparison of mineral trioxide aggregate (MTA) and 20% formocresol (FC) in pulpotomized human primary molars. Available from www.clinicaltrials.gov/show/ (accessed 5 June 2014). CENTRAL

NCT01010451 {published data only}

Antimicrobial pulpotomy of primary molars. Available from www.clinicaltrials.gov/ct2/show/record/NCT01010451 (accessed 26 June 2017). CENTRAL

NCT01591278 {published data only}

NCT01591278. MTA and biodentine in pulpotomized primary molars. Available from www.clinicaltrials.gov/ct2/show/record/NCT01591278 (accessed 28 November 2017). CENTRAL

NCT01733420 {published data only}

NCT01733420. Biodentine versus white MTA pulpotomy. Available from www.clinicaltrials.gov/ct2/show/record/NCT01733420 (accessed 28 November 2017). CENTRAL

NCT02137967 {published data only}

Sodium hypochlorite pulpotomies in primary molars: comparison with conventional 20% formocresol pulpotomies. Available from www.clinicaltrials.gov/ct2/show/record/NCT02137967 (accessed 26 June 2017). CENTRAL

NCT02201498 {published data only}

Randomized clinical trial for primary molar pulpotomy, biodentine vs formocresol‐ZOE. Available from www.clinicaltrials.gov/ct2/show/record/NCT02201498 (accessed 26 June 2017). CENTRAL

NCT02286648 {published data only}

Success rate evaluation of miniature pulpotomy with MTA in primary molars. Available from www.clinicaltrials.gov/ct2/show/record/NCT02286648 (accessed 26 June 2017). CENTRAL

NCT02298504 {published data only}

Vital pulp treatment in primary teeth. Available from www.clinicaltrials.gov/ct2/show/record/NCT02298504 (accessed 26 June 2017). CENTRAL

NCT02393326 {published data only}

Biodentine partial pulpotomy of pulpally exposed primary molars. Available from www.clinicaltrials.gov/ct2/show/record/NCT02393326 (accessed 26 June 2017). CENTRAL

NCT02702505 {published data only}

Success and color stability of MTA pulpotomized primary molars: an RCT (MTA). Available from www.clinicaltrials.gov/ct2/show/record/NCT02702505 (accessed 26 June 2017). CENTRAL

NCT02783911 {published data only}

Comparison of mineral trioxide aggregate (MTA) & ferric sulfate (FS) pulpotomies. Available from www.clinicaltrials.gov/ct2/show/study/NCT02783911 (accessed 26 June 2017). CENTRAL

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NCT02789423. Clinical & radiographical evaluation of the effect of dycal & biodentine in DPC in primary teeth. www.clinicaltrials.gov/ct2/show/record/NCT02789423 (first received 3 June 2016). CENTRAL

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Aeinehchi 2007

Methods

RCT, parallel‐arm

Children randomly assigned

Conducted in the dental clinic of Azad University, Tehran, Iran. Operators were a dentist under the supervision of an endodontist

Participants

126 children, 126 teeth, mean age 6.5 years, standard deviation age 1.16 years, age range 5 to 9 years

Interventions

Group 1: Pulpotomy (formocresol); n = 75 (1 visit)

Rubber dam

Caries removal prior to pulpal access: not mentioned

Pulp access with high‐speed burr

Pulpotomy amputation with excavator

For haemostasis, moistened cotton pellet with saline

Irrigation with saline
Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by zonalin dressings before being restored with amalgam or glass‐ionomer cement

Group 2: Pulpotomy (MTA); n = 51 (1 visit)

Rubber dam

Caries removal prior to pulpal access: not mentioned

Pulp access with high‐speed burr

Pulpotomy amputation with excavator

For haemostasis, moistened cotton pellet with saline

Irrigation with saline MTA applied after pulpotomy, followed by amalgam

Outcomes

Clinical failure (spontaneous pain, swelling, pain on palpation or percussion and sinus tract formation, periodontal ligament widening, furcal radiolucency or apical radiolucency), pathological root resorption: evaluation at 3 and 6 months (at tooth level)

Radiological failure (pathological root resorption, periodontal ligament widening and apical, lateral or furcal radiolucency): evaluation at 3 months (at tooth level)

Notes

Reasons for dropouts: quote: "18 in the FC group and 8 in the MTA group did not attend the 3‐month follow‐up"

Comment: 55 participants excluded: not meeting inclusion (39 children), refused to participate (12 children), other reasons (4 children)

Source of funding: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random number producing system

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Agamy 2004

Methods

RCT, split‐mouth

Teeth randomly assigned

Conducted in the Paediatric Dentistry Department, Alexandria University, Alexandria, Egypt. Operators not mentioned

Participants

24 children, 72 teeth, mean age 6.1 years, age range 4‐8 years

Interventions

Group 1: Pulpotomy (grey MTA); n = 24 (1 visit)

Rubber dam

Caries removal prior to pulpal access not mentioned

Pulp access with high‐speed bur

Pulpotomy amputation with excavator

For haemostasis, moistened cotton pellet with water

No irrigation

Grey MTA (3:1 powder:saline ratio) applied after pulpotomy, followed by IRM dressings before being restored with stainless‐steel crowns

Group 2: Pulpotomy (white MTA); n = 24 (1 visit)

Rubber dam

Caries removal prior to pulpal access not mentioned

Pulp access with high‐speed bur

Pulpotomy amputation with excavator

For haemostasis, moistened cotton pellet with water

No irrigation

White MTA (3:1 powder:saline ratio) applied after pulpotomy, followed by IRM dressings before being restored with stainless‐steel crowns

Group 3: Pulpotomy (formocresol); n = 24 (1 visit)

Rubber dam

Caries removal prior to pulpal access not mentioned

Pulp access with high‐speed bur

Pulpotomy amputation with excavator

For haemostasis, moistened cotton pellet with water

No irrigation

Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE and IRM dressings before being restored with stainless‐steel crowns

Outcomes

Clinical success (no pain symptoms, or no tenderness to percussion, or no swelling, or no fistulation, or no pathological mobility), radiographic success (no radicular radiolucency, or internal or external resorption, or periodontal ligament space widening), radicular radiolucency, pulp canal obliteration: evaluation at 1, 3, 6 and 12 months (at tooth level)

Notes

Reasons of dropouts: quote: "Four children with 12 pulpotimized molars, failed to return for evaluations and were excluded from the study"

Comment: 17% of participants (8% of teeth) dropped out of the study. The reasons for failure to return were not reported

Source of funding: quote "This study was supported by the Zawawi Pediatric Dentistry Fund of the Indiana University Foundation. [...] The authors also wish to thank Dentsply Tulsa Dental for donating the MTA materials used in this study"

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to make a judgement

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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: "Two examiners, who were blinded to the treatment type, evaluated the teeth clinically"

Blinding of radiological outcomes assessment

Low risk

Quote: "Two examiners, who were blinded to the treatment type, evaluated the teeth [...] and radiographically"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Akcay 2014

Methods

RCT, split‐mouth

Teeth randomly assigned

Conducted in the Pediatric Dentistry Department, Faculty of Dentistry, Ankara University. Operators not mentioned

Participants

64 children, 128 teeth, mean age 8.2 years, age range 6‐10 years

Interventions

Group 1: Pulpotomy (CH NaCOl); n = 31 (1 visit)

Rubber dam

Caries removal prior to pulpal access not mentioned

Pulp access not mentioned

Pulpotomy amputation with excavator

For haemostasis, dry cotton pellet

Irrigation with 5% NaOCl for 30 seconds, then water

CH, followed by IRM then stainless steel crown

Group 2: Pulpotomy (CH); n = 31 (1 visit)

Rubber dam

Caries removal prior to pulpal access not mentioned

Pulp access not mentioned

Pulpotomy amputation with excavator

For haemostasis, dry cotton pellet

Irrigation with saline for 30 seconds then water

CH, followed by IRM then stainless steel crown

Group 3: Pulpotomy (MTA NaOCl); n = 31 (2 visits)

Rubber dam

Caries removal prior to pulpal access not mentioned

Pulp access not mentioned

Pulpotomy amputation with excavator

For haemostasis, dry cotton pellet

Irrigation with 5% NaOCl for 30 seconds then water

MTA, followed by a moistened cotton pellet, followed by IRM. Second visit: IRM and the cotton pellets were removed after 24 hours, then stainless steel crown

Group 4: Pulpotomy (MTA); n = 31 (2 visits)

Rubber dam

Caries removal prior to pulpal access not mentioned

Pulp access not mentioned

Pulpotomy amputation with excavator

For haemostasis, dry cotton pellet

Irrigation with saline for 30 seconds then water

MTA, followed by a moistened cotton pellet, followed by IRM. Second visit: IRM and the cotton pellets were removed after 24 hours, then stainless steel crown

Outcomes

clinical success (absence of spontaneous pain, pathologic mobility, tenderness to percussion, swelling, fistula, or gingival inflammation), radiographic success (absence of internal/external root resorption and periapical/furcal radiolucency), calcific metamorphosis of the pulp: evaluation at 3, 6, 9 and 12 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

a toss of a coin

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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: "One examiner, who was blinded to treatment type, evaluated the teeth clinically "

Blinding of radiological outcomes assessment

Low risk

quote: "One examiner, who was blinded to treatment type, evaluated the teeth [...] radiographically"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

missing data balanced in numbers across intervention groups, with similar reasons for missing data across groups (2 in each group because of uncontrolled bleeding)

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Al‐Ostwani 2016

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Pedodontics and Preventive Dentistry at School of Dentistry, Damascus, Syria. Operators not mentioned

Participants

39 children, 64 teeth, mean age 8.2 years, age range 3 to 9 years

Interventions

Group 1: Pulpectomy (zinc oxide and propolis); n = 16 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high speed

  • Pulpotomy amputation with excavator

  • Irrigation with 5.25% sodium hypochlorite then distilled water the working length was determined by electronic apex locator, the root canals were prepared manually using K file up to size no. 30 root canals were dried with paper point (size 25)

  • The hydrolytic propolis of ZOP paste was extracted from raw Propolis. ZOP paste was synthesised by mixing 50% zinc oxide powder with 50% hydrolytic propolis, to form radiopaque paste with appropriate viscosity for filling the root canal. Paste was inserted into the root canal using Lentulo spirals at low speed. a thin layer of the filling paste was put on the floor of pulp chamber, followed by glass‐ionomer cement then stainless steel crown

Group 2: Pulpectomy (endoflas‐chlorophenol‐free); n = 16 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high speed

  • Pulpotomy amputation with excavator

  • Irrigation with 5.25% sodium hypochlorite then distilled water

  • the working length was determined by electronic apex locator, the root canals were prepared manually using K file up to size no. 30

  • root canals were dried with paper point (size 25)

  • The powder of Endoflas‐CF paste was synthesized by adding 56.5% zinc oxide, 40.6% iodoform, 1.63% barium sulphate and 1.07% calcium hydroxide, and mixed with eugenol without adding chlorophenol. Paste was inserted into the root canal using Lentulo spirals at low speed.

  • A thin layer of the filling paste was put on the floor of pulp chamber, followed by glass‐ionomer cement then stainless steel crown

Group 3: Pulpectomy (Metapex); n = 16 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high speed

  • Pulpotomy amputation with excavator

  • Irrigation with 5.25% sodium hypochlorite then distilled water

  • The working length was determined by electronic apex locator, the root canals were prepared manually using K file up to size no. 30

  • Root canals were dried with paper point (size 25)

  • Performed syringe with disposable plastic needles to inject the paste into the root canal; after inserting the tape of the needle near the apex, and the paste was gently pressed into the canal pulling the tape back slowly until the canal was filled.

  • A thin layer of the filling paste was put on the floor of pulp chamber, followed by glass‐ionomer cement then stainless steel crown

Group 4: Pulpectomy (ZOE); n = 16 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high speed

  • Pulpotomy amputation with excavator

  • Irrigation with 5.25% sodium hypochlorite then distilled water

  • the working length was determined by electronic apex locator, the root canals were prepared manually using K file up to size no. 30

  • root canals were dried with paper point (size 25)

  • Paste was inserted into the root canal using Lentulo spirals at low speed.

  • a thin layer of the filling paste was put on the floor of pulp chamber, followed by glass‐ionomer cement then stainless steel crown

Outcomes

Clinical success (no abnormal mobility, pain, or sensitivity to percussion), radiographic success (decrease in the size of radiolucency and the presence of bone regeneration), at 6 and 12 months. Treatment failure was classified into two degrees as (a) the radiolucency slightly increased in size, but it was separated from succeeding bud with adequate bone and (b) the radiolucency threatening the succeeding buds, so the tooth was extracted.

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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: "The treated molars were evaluated double‐blindly by three observers"

Blinding of radiological outcomes assessment

Low risk

Quote: "The treated molars were evaluated double‐blindly by three observers"

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

Alaçam 1989

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in Turkey. Setting and operators not mentioned

Participants

42 children, 69 teeth, age range 7 to 11 years

Interventions

Group 1: Pulpotomy (glutaraldehyde + ZOE); n = 25 (1 visit)

  • No rubber dam: cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • For haemostasis, dry cotton pellet

  • Irrigation with 3% hydrogen peroxide and sterile saline

  • Cotton wool pellet soaked with 2% unbuffered glutaraldehyde placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE. Final restoration not mentioned

Group 2: Pulpotomy (glutaraldehyde + calcium hydroxide); n = 21 (1 visit)

  • No rubber dam: cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • For haemostasis, dry cotton pellet

  • Irrigation with 3% hydrogen peroxide and sterile saline

  • Cotton wool pellet soaked with 2% unbuffered glutaraldehyde placed on pulp stumps for 5 minutes after pulpotomy, followed by CH. Final restoration not mentioned

Group 3: Pulpotomy (formocresol + ZOE); n = 23 (1 visit)

  • No rubber dam: cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • For haemostasis, dry cotton pellet

  • Irrigation with 3% hydrogen peroxide and sterile saline

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE.

  • Final restoration not mentioned

Outcomes

Clinical success (pain symptoms, thermal sensitivity, tenderness to percussion, changes in the mucous membrane in the surrounding area, sensitivity to sour, sensitivity to sweet), radiological success (internal root resorption, changes in the integrity of lamina dura, abnormalities in the structure of trabecular bone): evaluation at 3 months (at tooth level)

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No missing outcome data

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Alaçam 2009

Methods

RCT, parallel‐arm

Children randomly assigned

Conducted in the University of Gazi Department of Pediatric Dentistry, Turkey. Operators were undergraduate dental students supervised by members of senior staff clinics

Participants

105 children, 105 teeth, mean age 6.4 years, age range 4 to 8 years

Interventions

Group 1: Pulpotomy (formocresol); n = 35 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet with saline

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 3 minutes after pulpotomy, followed by 1 non‐specified medicament dressings before being restored with stainless‐steel crowns

Group 2: Pulpotomy (calcium hydroxide); n = 35 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet with saline

  • No irrigation

  • CH applied after pulpotomy, followed by one non‐specified medicament dressings before being restored with stainless‐steel crowns

Group 3: Pulpotomy (calcium hydroxide/iodoform)n = 35 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet with saline

  • No irrigation

  • CH/iodoform applied after pulpotomy, followed by 1 non‐specified medicament dressings before being restored with stainless‐steel crowns

Outcomes

Clinical success (teeth remained asymptomatic, no tenderness to percussion, no sinus tract or no premature tooth loss), radiological success (no furcal or periapical radiolucencies or internal or external root resorption), tenderness to percussion, swelling, spontaneous pain, fistula, internal root resorption, external root resorption, periapical radiolucency, furcal radiolucency, widened periodontal ligament: evaluation at 1, 3, 6, 9 and 12 months (at tooth level)

Notes

Quote: "9 children, with 9 pulpotomized molars, failed to return for evaluations and were excluded from the study"

"5 bleeding cases were excluded from analysis"

Group 1 ‐ received intervention, n = 35; no exclusions

Group 2 ‐ received intervention, n = 33; excluded due to uncontrolled bleeding from paste placement n = 2

Group 3 ‐ received intervention, n = 32; excluded due to uncontrolled bleeding from paste placement n = 3

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Low risk

Quote: "Radiographic outcome assessments were made by the primary investigator and 1 independent experienced clinician who was blind to the treatment"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Aminabadi 2016

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Pediatric Dentistry, Tabriz University of Medical Science, Iran. Operator was an expert paediatric dentist.

Participants

83 children, 160 teeth, mean age 5.14 years, age range 3 to 6 years

Interventions

Group 1: direct pulp capping (3 Mix); n = 40 (1 visit)

  • Rubber dam

  • Chlorhexidine

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • Irrigation with water and 1% of NaOCl delivered by a syringe and needle every 3 min to wash away dentin debris and remove the blood clot, if present

  • For haemostasis, moistened cotton pellet

  • 3Mix mixed with normal saline to form a creamy mixture and were delivered to the exposure site using a small amalgam carrier to reach a thickness of 1.5 to 2 mm and extending 2 mm beyond the margins of the exposure site

  • dry cotton pellet was pressed slightly for better adaptation of capping material with pulp at the exposure site. After removing the cotton pellet, the capping material was covered by IRM then glass ionomer before being restored by amalgam.

Group 2: direct pulp capping (3 Mixtatin); n = 40 (1 visit)

  • Rubber dam

  • Chlorhexidine

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • Irrigation with water and 1% of NaOCl delivered by a syringe and needle every 3 min to wash away dentin debris and remove the blood clot, if present

  • For haemostasis, moistened cotton pellet

  • 3Mixtatin mixed with normal saline to form a creamy mixture and were delivered to the exposure site using a small amalgam carrier to reach a thickness of 1.5–2 mm and extending 2 mm beyond the margins of the exposure site

  • dry cotton pellet was pressed slightly for better adaptation of capping material with pulp at the exposure site. After removing the cotton pellet, the capping material was covered by IRM then glass ionomer before being restored by amalgam.

Group 3: direct pulp capping (simvastatin); n = 40 (1 visit)

  • Rubber dam

  • chlorhexidine

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • Irrigation with water and 1% of NaOCl delivered by a syringe and needle every 3 min to wash away dentin debris and remove the blood clot, if present

  • For haemostasis, moistened cotton pellet

  • Simvastatin mixed with normal saline to form a creamy mixture and were delivered to the exposure site using a small amalgam carrier to reach a thickness of 1.5–2 mm and extending 2 mm beyond the margins of the exposure site

  • dry cotton pellet was pressed slightly for better adaptation of capping material with pulp at the exposure site. After removing the cotton pellet, the capping material was covered by IRM then glass ionomer before being restored by amalgam.

Group 4: direct pulp capping (White MTA); n = 40 (1 visit)

  • Rubber dam

  • chlorhexidine

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • Irrigation with water and 1% of NaOCl delivered by a syringe and needle every 3 min to wash away dentin debris and remove the blood clot, if present

  • For haemostasis, moistened cotton pellet

  • MTA mixed with normal saline to form a creamy mixture and were delivered to the exposure site using a small amalgam carrier to reach a thickness of 1.5–2 mm and extending 2 mm beyond the margins of the exposure site

  • wet cotton pellet was pressed slightly for better adaptation of capping material with pulp at the exposure site. After removing the cotton pellet, the capping material was covered by IRM then glass ionomer before being restored by amalgam.

Outcomes

Failure of treatment: pain, tenderness to palpation and percussion, sinus tract, and swelling; presence of internal or external root resorption, inter‐radicular radiolucency, and periapical lesion: evaluation at 12 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Using a computer random number generator

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Quote: "The operator was not blinded to the treatment because of different manipulation techniques implemented for the study groups"

Blinding of clinical outcomes assessment

Low risk

Quote: "clinical and radiographic examinations were conducted at each appointment by two experienced paediatric dentists that were blinded to the techniques applied to each group"

Blinding of radiological outcomes assessment

Low risk

Quote: "clinical and radiographic examinations were conducted at each appointment by two experienced paediatric dentists that were blinded to the techniques applied to each group"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Missing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Aminabadi 2010

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Pediatric Dentistry at Tabriz University of Medical Sciences School of Dentistry, Iran. Operators not mentioned

Participants

84 children, 120 teeth, mean age 4.4 years, age range 4 to 5 years

Interventions

Group 1: Direct pulp capping (formocresol + ZOE); n = 60 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • No pulpotomy amputation

  • Haemostasis not mentioned

  • Irrigation with saline

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes for direct pulp capping, followed by ZOE dressings before being restored with stainless‐steel crowns

Group 2: Direct pulp capping (calcium hydroxide + ZOE); n = 60 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • No pulpotomy amputation

  • Haemostasis not mentioned

  • Irrigation with saline

  • CH applied for direct pulp capping, followed by ZOE dressings before being restored with stainless‐steel crowns

Outcomes

Clinical success (spontaneous pain, or pain initiated by stimuli; signs of a defective restoration or recurrent caries; signs of mobility, sinus formation, tenderness to percussion, or soft tissue swelling; and signs of exfoliation, mobility or signs/symptoms of the successor tooth erupting), radiological success (defective restoration or recurrent caries; periradicular pathology such as periapical or furcal radiolucency; and pathological internal resorption, replacement resorption, intracanal calcifications, or physiological root resorption): evaluation at 24 months (at tooth level)

Spontaneous pain, tenderness to percussion, fistula or parulis, periapical radiolucency or furcal radiolucency, internal resorption or external resorption: evaluation at 6, 12, 18 and 24 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Coin toss

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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: "objectivity was maximized by not having direct access during [...] clinical evaluation to records detailing which pulp therapy agent was used"

Blinding of radiological outcomes assessment

Low risk

Quote: "objectivity was maximized by not having direct access during [...] radiological evaluation to records detailing which pulp therapy agent was used"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No missing outcome data

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Ansari 2010

Methods

RCT, split‐mouth

Teeth randomly assigned

Conducted in the Paedodontic Department at Shahid Beheshti University, Dental School, Iran. Operator was an investigator

Participants

17 children, 40 teeth, age range 4 to 9 years

Interventions

Group 1: Pulpotomy (formocresol); n = 20 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet with saline

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by IRM dressings before being restored with amalgam or stainless‐steel crowns

Group 2: Pulpotomy (MTA); n = 20 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet with saline

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by IRM dressings before being restored with amalgam or stainless‐steel crowns

  • MTA applied after pulpotomy, then temporarily filled using an IRM, until the second visit for placement of ZOE base. dressings before being restored with stainless‐steel crowns

Outcomes

Signs of failure (internal resorption, radiographic signs of pathosis (periapical radiolucency), report of pain, presence of gingival swelling and sinus tract): evaluation at 24 months (at tooth level)

Fistula, furcal radiolucency, periapical radiolucency, internal resorption, external resorption, periodontal ligament widening, pulp canal obliteration: evaluation at 6, 12 and 24 months (at tooth level)

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Arikan 2016

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in Turkey. Operator was a paediatric dentist

Participants

50 children, 50 teeth, age range 4 to 9 years

Interventions

Group 1: Pulpectomy (IRM); n = 25 (3 visits)

  • isolation with no precision

  • Caries removal prior to pulpal access

  • Pulp access with no precision

  • Pulpotomy amputation with no precision

  • Irrigation with 2.5% sodium hypochlorite and physiological saline

  • Instrumentation with H‐files

  • canals were dried with paper points and Cresophene was applied in the pulp chamber with a cotton pellet and tooth was filled with Cavit. After 48 hours, canals were irrigated with NaOCl and physiologic saline, dried with paper points, and filled with a Ca(OH)2/iodoform paste using plastic syringe provided by the manufacturer and Lentulo spirals. Following root canal fillings, base materials were applied to the cavity floor and cavities were temporarily filled with IRM. IRM was removed from the cavity until approximately 3mm of the material is left on the pulpal floor and the cavity was filled with metal‐reinforced glass ionomer cement, before being restored with stainless steel crowns

Group 2: Pulpectomy (MTA); n = 25 (3 visits)

  • isolation with no precision

  • Caries removal prior to pulpal access

  • Pulp access with no precision

  • Pulpotomy amputation with no precision

  • Irrigation with 2.5% sodium hypochlorite and physiological saline

  • Instrumentation with H‐files

  • canals were dried with paper points and Cresophene was applied in the pulp chamber with a cotton pellet and tooth was filled with Cavit. After 48 hours, canals were irrigated with NaOCl and physiologic saline, dried with paper points, and filled with a Ca(OH)2/iodoform paste using plastic syringe provided by the manufacturer and Lentulo spirals. Following root canal fillings, base materials were applied to the cavity floor and cavities were temporarily filled with IRM. after approximately 3mm of MTA was placed on the pulpal floor a moistened cotton pellet in contact to MTA was left in the cavity before the application of the temporary filling material. After 24 hours, temporary filling and moistened cotton pellet were removed and the cavity was filled with metal‐reinforced glass ionomer cement, before being restored with stainless steel crowns

Outcomes

Clinical failure (pain, pathological mobility, tenderness to percussion and palpation, and any soft tissue pathology and sinus tract) and radiographical failure (pathological root resorption, reduced size or healing of existing lesion, and absence of new lesions at the interradicular or periapical area): evaluation at 3, 6, 12 and 18 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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: "Examiners were blinded to the groups"

Blinding of radiological outcomes assessment

Low risk

Quote: "Examiners were blinded to the groups"

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

Bahrololoomi 2008

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Pedodontics Department of Yazd Faculty of Dentistry, Iran. Operators were the principal investigator or co investigators

Participants

46 children, 70 teeth, mean age 6.1 years, standard deviation age 1.4 years, age range 4 to 10 years

Interventions

Group 1: Pulpotomy (formocresol); n = 35 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator, slow‐speed bur, or both

  • For haemostasis, cotton pellet

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE dressings before being restored with amalgam

Group 2: Pulpotomy (electrosurgery); n = 35 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator, slow‐speed bur, or both

  • For haemostasis, cotton pellet

  • No irrigation

In the experimental electrosurgical group, a series of large, sterile cotton pellets were placed in the chamber with pressure to obtain temporary haemostasis. The cotton pellets were then removed and the electrosurgery dental U‐shaped electrode (Whaledent perfect TCS, Colten Whaledent Inc., USA) was immediately placed 1 to 2 mm above the tissue. The electrosurgery unit power was set at 40%. The electrical arc was allowed to bridge the gap to the first pulpal stump for 1 second followed by a cool‐down period of 10 to 15 seconds. Heat was minimised by keeping the electrode as far away from the pulpal stumps and the tooth structure as possible while still allowing electrical arcing to occur. This procedure was repeated up to 3 times at each pulpal orifice. To avoid heat build‐up in any 1 area of the tooth, single applications of 1 second were performed to each orifice in a rotational sequence. After each current application, a new large sterile cotton pellet was placed with pressure on the next pulpal orifice to be electrosurgically treated to absorb any blood or tissue fluid before the next current application (i.e. pellet‐electrode‐pellet‐electrode). Pulpal stumps were dry and blackened, followed by ZOE dressings before being restored with amalgam

Outcomes

Clinical success (absence of pain, abscess, fistula or excessive mobility), radiological success (presence of a normal periodontal ligament space, absence of pathological root resorption or canal calcification, and no periradicular or furcal radiolucency): evaluation at 9 months (at tooth level)

Pain symptoms, fistula, pathological mobility, abscess, furcal radiolucency, internal resorption, external resorption: evaluation at 3, 6 and 9 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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: "...examiner who was ...blind to the treatment"

Blinding of radiological outcomes assessment

Low risk

Quote: "...examiner who was ...blind to the treatment"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No missing outcome data

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Bezgin 2016

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in Turkey. Operator was a paediatric dentist

Participants

16 children, 20 teeth, age range 6 to 13 years, mean age 10.5 years

Interventions

Group 1: Pulpectomy (gutta‐percha/AH‐Plus); n = 10 (1 visit)

  • rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access with no precision

  • Pulpotomy amputation with no precision

  • Irrigation with 1% sodium hypochlorite and physiological saline

  • Instrumentation with K‐files and barbed broaches

  • Canals were completely filled with gutta‐percha points using a Size 30 master cone and Size 25, 20 and 15 accessory cones applied with finger spreaders sizes 25 and 20 and AH‐Plus Sealer using a cold lateral condensation technique. Final restorations were completed in the same session using reinforced glass ionomer cement and composite resin.

Group 2: Pulpectomy (MTA); n = 10 (2 visits)

  • rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access with no precision

  • Pulpotomy amputation with no precision

  • Irrigation with 1% sodium hypochlorite and physiological saline

  • Instrumentation with K‐files and barbed broaches

  • White MTA was mixed according to the manufacturer’s recommendations, placed in the canal using the MTA Gun System and compacted using endodontic pluggers. The MTA was allowed to set completely by placing a cotton pellet moistened with sterile water inside the pulp chamber and temporarily sealing the access cavity with reinforced glass ionomer cement. After 2 days, the temporary restoration was removed, and the cavities were permanently restored using reinforced glass ionomer cement and composite resin as a final restoration.

Outcomes

Clinical success (no symptoms of pain, tenderness to percussion, swelling, and presence of a fistula or pathological mobility), radiographic success (no evidence of periradicular or interradicular radiolucency or internal or external root resorption): evaluation at 6, 12, 18, 24 and 36 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

High risk

Quote: "examiners could not be blinded to the type of the root canal filling"

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

Cantekin 2014

Methods

RCT, split‐mouth

Teeth randomly assigned

Conducted in the clinic of the Department of Pediatric Dentistry, Erciyes University, Kayseri, Turkey. Operators were not mentioned

Participants

35 children, 70 teeth, age range 4 to 6 years

Interventions

Group 1: Pulpotomy (Ankaferd Blood Stopper); n = 35 (1 or 2 visits)

  • Isolation not mentioned

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, water dampened cotton pellets

  • Irrigation with saline solution applied on the pulp stumps with a dental syringe for 15 seconds, and the pulp stumps were rinsed with saline solution and pulp chamber was dried with sterile cotton pellets, followed by IRM dressings before being restored with glass ionomer cement then stainless steel crown

Group 2: Pulpotomy (FS); n = 35 (1 or 2 visits)

  • Isolation not mentioned

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, water dampened cotton pellets

  • Irrigation with saline solution applied on the pulp stumps with a dental syringe for 15 seconds, and the pulp stumps were rinsed with saline solution and pulp chamber was dried with sterile cotton pellets, followed by IRM dressings before being restored with glass ionomer cement then stainless steel crown

Outcomes

Clinical failure (pain, tenderness to percussion, gingival abscess, sinus/fistula, and pathological mobility), radiographic success (absence of abnormal root resorption, internal root resorption, furcation involvement, and periapical bone destruction), Calcification in pulpal tissue and pulp canal obliteration: evaluation at 3, 6, 9 and 12 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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: "All pre‐ and postoperative clinical and digital radiographic examinations were performed at followup by one experienced investigator who was blind to the group being studied"

Blinding of radiological outcomes assessment

Low risk

Quote: "All pre‐ and postoperative clinical and digital radiographic examinations were performed at followup by one experienced investigator who was blind to the group being studied"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Casas 2004

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Hospital for Sick Children, Toronto, Canada. Operators were 3 paediatric dentists

Participants

130 children, 291 teeth, mean age 4.4 years, standard deviation age 1.3 years

Interventions

Group 1: Pulpotomy (ferric sulphate); n = 182 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed, followed by slow‐speed bur

  • Pulpotomy amputation with slow speed bur

  • Haemostasis not mentioned

  • No irrigation

  • A 16% FS equivalent in an aqueous vehicle was gently burnished on the pulp stumps with the syringe applicator for 15 seconds after pulpotomy. Then the pulp chamber was flushed with water supplied by an air‐water syringe, followed by fortified ZOE mixture supplied in pre‐measured capsules dressings before being restored with amalgam or stainless‐steel crowns

Group 2: Pulpectomy (ZOE); n = 109 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed, followed by slow‐speed bur

  • Pulpotomy amputation not mentioned

  • No haemostasis

  • No irrigation

  • Instrumentation with files

  • The canals were then irrigated and gently air dried using an air‐water syringe, then viscous mixture of Sedanol (a fine‐grained, non‐reinforced ZOE) was delivered to the root canal with a spiral paste filler inserted into the canal to a point just short of the apex, dressings before being restored with stainless‐steel crowns

Outcomes

Radiological success (N ‐ normal molar without evidence of radiographic change or H ‐ radiographic changes associated with normal physiological molar resorption): evaluation at 36 months (at tooth level)

Furcal radiolucency, periapical radiolucency, internal root resorption, external resorption, periodontal ligament widening, pulp canal obliteration, N (score 4‐rx), H (score 4‐rx), Po (score 4‐rx), Px (score 4‐rx), pain symptoms, tenderness to percussion, (swelling or parulis), (fistula or swelling): evaluation at 24 and 36 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Celik 2013

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the paediatric dental clinic at the School of Dentistry, Hacettepe University, Ankara, Turkey. Operator was a paediatric dentist.

Participants

75 children, 139 teeth, 3 to 9 years

Interventions

Group 1: Pulpotomy (ProRoot MTA); n = 46 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed, followed by slow‐speed bur

  • Pulpotomy amputation with high speed followed by excavator

  • Haemostasis with saline‐moistened sterile cotton pellets for two to four minutes

  • Irrigation with saline

  • White MTA mixed according to the manufacturer’s instructions to produce a homogenous paste.The material was placed in the pulp chamber with a plastic carrier. Light pressure was applied with moist cotton pellets to enhance adaptation of the material. Then followed by conventional glass ionomer cement then by amalgam (followed by fissure sealant at the margins).

Group 2: Pulpotomy (MTA Angelus); n = 45 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed, followed by slow‐speed bur

  • Pulpotomy amputation with high speed followed by excavator

  • Haemostasis with saline‐moistened sterile cotton pellets for two to four minutes

  • Irrigation with saline

  • Angelus MTA mixed according to the manufacturer’s instructions to produce a homogenous paste.The material was placed in the pulp chamber with a plastic carrier. Light pressure was applied with moist cotton pellets to enhance adaptation of the material. Then followed by conventional glass ionomer cement then by amalgam (followed by fissure sealant at the margins).

Group 3: Pulpotomy (CH); n = 48 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed, followed by slow‐speed bur

  • Pulpotomy amputation with high speed followed by excavator

  • Haemostasis with saline‐moistened sterile cotton pellets for two to four minutes

  • Irrigation with saline

  • Calcium hydroxide powder mixed with sterile water in a 3:1 ratio to produce a homogeneous paste. The material was placed in the pulp chamber as described for groups 1 and 2.

  • Then followed by conventional glass ionomer cement then by amalgam (followed by fissure sealant at the margins).

Outcomes

Clinical success (absence of spontaneous pain and/ or sensitivity to palpation/percussion; absence of fistula, swelling, and/or abnormal mobility), radiological success (absence of radiolucencies at the inter‐radicular and/or periapical regions, absence of pulp canal obliteration (fully obliterated canals); and absence of internal or external (pathologic) resorption), defective restoration (clinically): evaluation at 1, 3, 6, 12, 18, 24 months

Notes

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

Quote: "...sequentially numbered opaque‐sealed envelopes"

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Quote: "Operator blinding was not possible"

Blinding of clinical outcomes assessment

Low risk

Quote: "Two calibrated operators, blinded to group assignment and treatment, performed ...clinical ...recall examinations"

Blinding of radiological outcomes assessment

Low risk

Quote: "Two calibrated operators, blinded to group assignment and treatment, performed ...radiographic recall examinations"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Chandra 2014

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in India. Operator not mentioned.

Participants

52 children, 60 teeth, 3.8 to 7.6 years

Interventions

Group 1: Pulpectomy (ozonated oil‐ZO); n = 30 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access

  • Pulpotomy amputation not mentioned

  • Instrumentation with barbed broaches and K‐files

  • Irrigation with 2.5 % sodium hypochlorite and normal saline

  • The root canals were filled 1 mm short of the apex with a mixture of ZO powder (0.2 g, arsenic free) and ozonated sesame oil using Lentulo spirals, before being restored with stainless steel crowns

Group 2: Pulpectomy (ZOE); n = 30 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access

  • Pulpotomy amputation not mentioned

  • Instrumentation with barbed broaches and K‐files

  • Irrigation with 2.5 % sodium hypochlorite and normal saline

  • The root canals were filled 1 mm short of the apex with ZOE using Lentulo spirals, before being restored with stainless steel crowns

Outcomes

Clinical success (absence of pain, tenderness to percussion, absence or decrease in mobility and sinus opening), radiographic success (signs of resolution in the radiolucency, no new signs of post‐operative radiolucency and no signs of internal or external pathological root resorption), radiographic failure (increase in postoperative inter‐radicular radiolucency or development of new postoperative radiolucency): evaluation at 12 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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: "The teeth were evaluated for success or failure based on clinical and radiographic criteria by a blinded investigator"

Blinding of radiological outcomes assessment

Low risk

Quote: "The teeth were evaluated for success or failure based on clinical and radiographic criteria by a blinded investigator"

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

Chen 2015

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Pediatric Dentistry, First Dental Center, Peking University School and Hospital of Stomatology, Beijing, China. Operator was one investigator

Participants

155 children, 160 teeth, average age: 5.88 ± 1.27 years

Interventions

Group 1: Pulpectomy (ZOE); n = 51 (2 visits)

  • Rubber dam

  • Instrumentation with files

  • Irrigation with 2,5% hypochlorite

  • Canal dried with sterile paper points

Group 2: Pulpectomy (Vitapex); n = 56 (2 visits)

  • Rubber dam

  • Instrumentation with files

  • Irrigation with 2,5% hypochlorite

  • Canal dried with sterile paper points

Group 3: Pulpectomy (MPRCF); n = 53 (2 visits)

  • First visit

  • Rubber dam

  • Instrumentation with files

  • Irrigation with 2,5% hypochlorite

  • Canal dried with sterile paper points

  • Calcium hydroxide placed into root canals

  • Temporary restoration with Cavit

  • Second visit (if signs or symptoms)

  • Canal filled with MPRCF

  • Adhesive restoration: Lime light (Pulpdent), Adper easy one bond (3M), Filtek Z250 (3M)

Outcomes

Clinical and radiologic success: evaluation at 6 and 12 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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: "...the clinical ...diagnoses were blindly assessed by other two investigators"

Blinding of radiological outcomes assessment

Low risk

Quote: "...the ...radiogaphic diagnoses were blindly assessed by other two investigators"

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

Coser 2008

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the University Center Heminio Ometto, School of  Dentistry, Araras, Sao Paulo, Brazil. Operators not mentioned

Participants

29 children, 51 teeth, age range 4.5 to 6.5 years

Interventions

Group 1: Pulpotomy (formocresol); n = 28 (4 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, dry cotton pellet

  • Irrigation with 0.5% saline

  • Pulpotomy, FC used. "The cavity was provisionally restored with an IRM …After 7 days, …the FC dressing was changed, and the cavity was sealed with an IRM again. After another 7 days, …the dressing was removed and the coronal chamber was restored with a slow‐setting pure ZOE. The tooth was sealed with IRM. One month later, the treated primary molars were restored with a glass‐ionomer cement …If the restoration was not satisfactory, it was substituted with a performed stainless steel crown"

Group 2: Pulpectomy (calcium hydroxide); n = 23 (4 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet with saline

  • Irrigation with 0.5% saline

  • Instrumentation with endodontic files

  • Pulpectomy then CH

  • "The tooth was temporarily sealed with an IRM …placed over a cotton pellet... After 7 days …a new calcium hydroxide paste dressing was introduced …and the tooth was temporarily sealed again. After an additional 7 days, definitive obturation of the canals was performed with calcium hydroxide paste …thickened with calcium hydroxide powder …and the tooth was sealed with IRM"

  • "One month later, the treated primary molars were restored with a glass‐ionomer cement …If the restoration was not satisfactory, it was substituted with a performed stainless steel crown"

Outcomes

No data provided

Notes

Dropouts: no information provided

Follow‐up for 48 months; reporting at baseline, 12, 24, 26, 48 months

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Cuadros‐Fernández 2016

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Paediatric Dentistry at the Universitat Internacional de Catalunya, Spain. Operator was a postgraduate student

Participants

68 children, 90 teeth, age range 4 to 9 years, mean 6.6 ± 1.3 years

Interventions

Group 1: Pulpotomy (MTA); n = 45 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur followed by slow speed bur

  • Pulpotomy amputation with slow speed bur

  • For haemostasis, sterile cotton pellet moistened with saline solution

  • Irrigation not mentioned

  • mixing MTA powder with sterile saline in a ratio of 3:1, IRM, stainless steel crown

Group 2: Pulpotomy (Biodentine); n = 45 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur followed by slow speed bur

  • Pulpotomy amputation with slow speed bur

  • For haemostasis, sterile cotton pellet moistened with saline solution

  • Irrigation not mentioned

  • mixing Biodentine powder with a single dose of liquid, IRM, stainless steel crown

Outcomes

Clinical success (no symptoms of pain, and there was no swelling or gingival inflammation, fistulation, or pathologic mobility), radiologic success (no evidence of internal or external resorption or periradicular radiolucency): evaluation at 6 and 12 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random number table

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Missing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups

Selective reporting (reporting bias)

Low risk

Protocol prospectively registered (NCT01591278). no discrepancies in outcomes between registered record and published RCT.

Dean 2002

Methods

RCT, parallel‐arm

Children randomly assigned

Conducted in the dental clinics of the Indiana University Institutional Review Board, USA. Operators were investigators: "...standardization of the investigators in the experimental technique was attempted by using a clinician with over 20 years of experience in performing the electrosurgical…"

Participants

50 children, 50 teeth mean age 5.3 years, age range 2.2 to 8.1 years

Interventions

Group 1: Pulpotomy (formocresol); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator, slow‐speed bur, or both

  • For haemostasis, dry cotton pellet

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by IRM dressings before being restored with stainless‐steel crown

Group 2: Pulpotomy (electrosurgery); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator, slow‐speed bur, or both

  • For haemostasis, dry cotton pellet

  • No irrigation

  • Pulpotomy, haemorrhage control with sterile cotton wool pellet and electrosurgery to pulp stumps. Maximum of 3 applications of 1 second to each pulpal orifice, with cool‐down periods of 5 seconds between applications to limit heat build‐up. Unit at 40% power. Followed by IRM dressings before being restored with stainless‐steel crown

Outcomes

Clinical success (no pain, no abscess, no fistula or no excessive mobility), radiological success (normal periodontal ligament space, no pathological root resorption, no canal calcification and no periradicular radiolucency): mean evaluation at 11.5 (range 5‐25) months for Group 1 and 10.9 (6‐31) for Group 2 (at tooth level)

Notes

Source of funding: quote: "This study was supported by Birtcher Medical Services, Inc"
Comment: Birtcher Medical Systems, Inc. is a USA manufacturer of medical and surgical instruments

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "...the patients were assigned randomly by the flip of a coin"

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No missing outcome data

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Demir 2007

Methods

RCT, parallel‐arm

Teeth randomly assigned

Setting not mentioned. Conducted in Turkey. Operators were investigators

Participants

67 children, 100 teeth, age range 5 to 9 years

Interventions

Group 1: Direct pulp capping (calcium hydroxide); n = 20 (1 visit)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • No pulpotomy amputation

  • For haemostasis, "sterile cotton pellets were soaked in the 1.25% sodium hypochlorite solution and place over the exposure site for 62 seconds without pressure"

  • Irrigation with saline

  • Direct pulp capping. CH cement "a non‐gamma II type amalgam was placed into the cavity in small increments with special care not to damage the CH cement during condensation. After occlusal adjustments and burnishing, the tooth‐amalgam margins were etched with 37% phosphoric acid for 30 seconds, rinsed with water for 15 seconds; dried and sealed with a light‐cured fissure sealant material to prevent short‐term microleakage that could affect healing"

Group 2: Direct pulp capping (acetone‐based total‐etch adhesive); n = 20 (1 visit)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • No pulpotomy amputation

  • For haemostasis, "sterile cotton pellets were soaked in the 1.25% sodium hypochlorite solution and place over the exposure site for 62 seconds without pressure"

  • Irrigation with saline

  • Acetone‐based total‐etch adhesive. Then composite: "incremental technique (each increment was polymerised for 40 seconds). Following standard techniques for finishing and polishing, the restoration surface was re‐etched as group 1 and sealed with an unfilled light‐cured resin to minimize microleakage"

Group 3: Direct pulp capping (acetone‐based total‐etch adhesive ‐ non rinse conditioner); n = 20 (1 visit)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • No pulpotomy amputation

  • For haemostasis, "sterile cotton pellets were soaked in the 1.25% sodium hypochlorite solution and place over the exposure site for 62 seconds without pressure"

  • Irrigation with saline

  • Non‐rinse conditioner. Then treatment 2. Then composite: "incremental technique (each increment was polymerised for 40 seconds). Following standard techniques for finishing and polishing, the restoration surface was re‐etched as group 1 and sealed with an unfilled light‐cured resin to minimize microleakage"

Group 4: Direct pulp capping (acetone‐based total‐etch adhesive ‐ total etching); n = 20 (1 visit)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • No pulpotomy amputation

  • For haemostasis, "sterile cotton pellets were soaked in the 1.25% sodium hypochlorite solution and place over the exposure site for 62 seconds without pressure"

  • Irrigation with saline

  • Total‐etching with 36% phosphoric acid. 36% phosphoric acid gel on enamel margins for 15 seconds followed by extending gel application to the cavity for an additional 10 seconds with care not to contact the exposed pulp. Then treatment 2. Then composite: "incremental technique (each increment was polymerised for 40 seconds). Following standard techniques for finishing and polishing, the restoration surface was re‐etched as group 1 and sealed with an unfilled light‐cured resin to minimize microleakage"

Group 5: Direct pulp capping (acetone‐based total‐etch adhesive ‐ self‐etch); n = 20 (1 visit)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • No pulpotomy amputation

  • For haemostasis, "sterile cotton pellets were soaked in the 1.25% sodium hypochlorite solution and place over the exposure site for 62 seconds without pressure"

  • Irrigation with saline

  • Self‐etch adhesive system. Then treatment 2. Then composite: "incremental technique (each increment was polymerised for 40 seconds). Following standard techniques for finishing and polishing, the restoration surface was re‐etched as group 1 and sealed with an unfilled light‐cured resin to minimize microleakage"

Outcomes

Clinical success (no spontaneous pain or sensitivity (or both) to pressure/percussion, no fistula, oedema, abnormal mobility, or a combination), radiological success (no radiolucency at the inter‐radicular or periapical regions (or both), no internal or external (pathological) resorption that was not compatible with the expected resorption due to the exfoliation process), inter‐radicular radiolucency or periapical radiolucency, internal root resorption or external root resorption, pain symptoms or spontaneous pain: evaluation at 1, 3, 6, 9, 12, 18 and 24 months (at tooth level)

Notes

Reasons for dropouts: 9 exfoliations (7 at 18 months, 2 at 24 months); 2 extractions (12 and 18 months), 1 extraction (6 months), 1 extraction (12 months)

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)

Unclear risk

Insufficient information to make a clear judgement

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: "...two calibrated operators, blinded to the treatments, performed the clinical ...recall examinations"

Blinding of radiological outcomes assessment

Low risk

Quote: "...two calibrated operators, blinded to the treatments, performed the ...radiological recall examinations"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Doyle 2010

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Hospital for Sick Children, Toronto, Canada. Operators were 3 paediatric dentists

Participants

112 children, 266 teeth, mean age 4.0 years, standard deviation age 1.1 years

Interventions

Group 1: Pulpotomy (FS + eugenol); n = 58 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high speed followed by slow speed

  • Pulpotomy amputation with slow speed

  • For haemostasis saline ‐ water flush

  • No irrigation

  • 15.5% aqueous FS solution was gently burnished with the syringe applicator for 15 seconds after pulpotomy, followed by IRM dressings before being restored with stainless‐steel crown

Group 2: Pulpotomy (FS); n = 78 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high speed followed by slow speed

  • Pulpotomy amputation with slow speed

  • For haemostasis saline ‐ water flush

  • No irrigation

  • Eugenol‐free FS. 15.5% aqueous FS solution was gently burnished with the syringe applicator for 15 seconds after pulpotomy, followed by Cimpact S dressings before being restored with stainless‐steel crown

Group 3: Pulpotomy (MTA); n = 53 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high speed followed by slow speed

  • Pulpotomy amputation with slow speed

  • For haemostasis, saline ‐ water flush

  • No irrigation

  • MTA (3:1 powder:water ratio) placed on pulp stumps after pulpotomy, followed by IRM dressings before being restored with stainless‐steel crown

Group 4: Pulpotomy (MTA + FS + eugenol); n = 77 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high speed followed by slow speed

  • Pulpotomy amputation with slow speed

  • For haemostasis saline ‐ water flush

  • No irrigation

  • FS: MTA. 15.5% aqueous FS solution was gently burnished with the syringe applicator then MTA 3:1 for 15 seconds after pulpotomy, followed by IRM dressings before being restored with stainless‐steel crown

Outcomes

Tenderness to percussion, pathological mobility, erythema, parulis, pathological radiolucency, internal root resorption, external root resorption, periodontal ligament widening, pulp canal obliteration, N (score 5‐rx), Po (score 5‐rx), Px (score 5‐rx): mean evaluation at 22 (range 6 to 38) months (at tooth level)

Quote: "Subjects were invited to return for clinical and radiographic assessments at 12, 24, and 36 months after treatment"

Notes

Source of funding: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated random numbers table

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Low risk

Quote: "2 blinded, disinterested raters classified each molar into 1 of 3 radiographic outcomes"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Durmus 2014

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the University of Marmara, Department of Paediatric Dentistry, in Istanbul. Operator was one paediatric dentist.

Participants

58 children, 120 teeth, age range 5 to 9 years

Interventions

Group 1: Pulpotomy (diode laser); n = 40 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation with slow speed followed by excavator

  • For haemostasis, dry cotton pellet

  • Irrigation not mentioned

  • A DL beam at a wavelength of 810 nm was transmitted. The DL fibre tip was kept 1–2mm from touching the tissue. The pulp at canal orifices was exposed with parameters of a frequency of 30 Hz and energy of 50 mJ, with a power of 1.5 W for 10 sec with air‐cooling operation mode without water. Followed by ZOE followed by glass ionomer cement before being restored with stainless‐steel crown

Group 2: Pulpotomy (formocresol); n = 40 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation with slow speed followed by excavator

  • For haemostasis, dry cotton pellet

  • Irrigation not mentioned

  • cotton pellet placed directly over the radicular pulp stumps and left for 5 min for fixation, followed by ZOE followed by glass ionomer cement before being restored with stainless‐steel crown

Group 3: Pulpotomy (ferric sulphate); n = 40 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation with slow speed followed by excavator

  • For haemostasis, dry cotton pellet

  • Irrigation not mentioned

  • FS applied by wiping the cotton tip on the pulp stumps for 15 sec. The pulp cavity was washed with saline to remove any blood clot particles, followed by ZOE followed by glass ionomer cement before being restored with stainless‐steel crown

Outcomes

Clinical failure (spontaneous pain, percussion/palpation, abscess, swelling, fistula, or pathologic mobility), radiological failure (periapical radiolucency, widened periodontal ligament space (PDL), pathologic internal/external root resorption, or pathological changes of the alveolar bone in the furcation): evaluation at 1, 3, 6, 9, and 12 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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: "The outcome assessment and data analysis were blinded "

Blinding of radiological outcomes assessment

Unclear risk

Quote: "The outcome assessment and data analysis were blinded " BUT "Two blinded observers evaluated a set of radiographs separately"

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

Eidelman 2001

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the undergraduate and graduate Pediatric Dentistry Clinics of the Hebrew University‐Hadassah School of Dental Medicine, Israel. Operators were authors

Participants

26 children, 45 teeth; 32 teeth from 18 children analysed, mean age 6.4 years, age range 5 to 12 years

Interventions

Group 1: Pulpotomy (formocresol); n = 17 teeth (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • Haemostasis not mentioned

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE and IRM dressings before being restored with stainless‐steel crown

Group 2: Pulpotomy (MTA); n = 15 teeth (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • Haemostasis not mentioned

  • No irrigation

  • MTA (3:1 powder:saline ratio) applied after pulpotomy, followed by IRM dressings before being restored with stainless‐steel crowns

Outcomes

Signs of failure (internal root resorption, furcation radiolucency, periapical bone destruction, pain, swelling, or sinus tract), internal root resorption, furcation radiolucency, periapical bone destruction, pain, swelling, or sinus tract: evaluation at 13 (6 to 30) months (at tooth level)

Notes

Reasons of dropouts: quotes: "a total of 45 primary molars were pulpotomized in 26 children. Of these 32 teeth in 18 children were available for follow‐up evaluation"; "4 children with 8 teeth had less than 6 months postoperative period at the time of data analysis. 3 children with 5 teeth were not available for follow‐up examination since they moved to another city"

Source of funding: not reported, although the MTA material was provided by a colleague at another university in the USA

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Coin toss

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement of Yes or No

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement of Yes or No

Blinding of clinical outcomes assessment

High risk

Quote: "the children were examined clinically at follow‐up by one of the 3 authors who were not blind to which treatment group the subject belong"

Blinding of radiological outcomes assessment

Low risk

Quote: "all 3 authors blindly evaluated the radiographs"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

El Meligy 2016

Methods

RCT, split‐mouth

Teeth randomly assigned

Conducted at the Pediatric Dental Clinics, Faculty of Dentistry, King Abdulaziz University (KAU), Jeddah. Operators not mentioned

Participants

37 children, 56 pairs, 112 teeth; mean age 6 ± 0.75 years, age range 4 to 8 years

Interventions

Group 1: Pulpotomy (formocresol); n = 56 teeth (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • Haemostasis with sterile wet cotton pellet

  • Irrigation with normal saline

  • Cotton wool pellet soaked with 1:5 diluted FC placed on pulp stumps for 5 minutes after pulpotomy, followed by IRM dressings before being restored with stainless‐steel crown

Group 2: Pulpotomy (Biodentine); n = 56 teeth (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • Haemostasis with sterile wet cotton pellet

  • Irrigation with normal saline

  • Biodentine before being restored with stainless‐steel crown

Outcomes

Clinical success (absence of sensitivity, pain, or swelling, no tenderness to percussion, no abscess or fistulation, no tooth mobility), radiographic success (absence of furcation and periapical radiolucency, absence of internal or external root resorption), presence of a normal periodontal ligament space, presence of pulp canal obliteration: evaluation at 3 and 6 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to make a clear judgement of Yes or No

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement of Yes or No

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement of Yes or No

Blinding of clinical outcomes assessment

Low risk

Quote: "Independently, two examiners who were blinded to treatment type evaluated the teeth clinically and radiographically."

Blinding of radiological outcomes assessment

Low risk

Quote: "Independently, two examiners who were blinded to treatment type evaluated the teeth clinically and radiographically."

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

Erdem 2011

Methods

RCT, parallel arm

Teeth randomly assigned

Setting not mentioned. Conducted in Turkey. Operators were 3 paediatric dentists

Participants

32 children, 100 teeth, mean age 6.2 years, standard deviation age 0.7 years. age range 5 to 7 years

Interventions

Group 1: Pulpotomy (MTA); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet

  • Irrigation with saline

  • MTA (3:1 powder:saline ratio) applied after pulpotomy, followed by ZOE dressings before being restored with stainless‐steel crowns

Group 2: Pulpotomy (ferric sulphate); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet

  • Irrigation with saline

  • 15.5% FS solution applied for 15 seconds after pulpotomy, followed by ZOE dressings before being restored with amalgam

Group 3: Pulpotomy (formocresol); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet

  • Irrigation with saline

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE dressings before being restored with amalgam

Group 4: n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • For haemostasis, dry moistened cotton pellet

  • Irrigation with saline

  • ZOE applied after pulpotomy dressings before being restored with amalgam

Outcomes

Clinical failure (pain, swelling, mobility, percussion pain), radiological failure (internal root resorption, and furcation or periapical bone destruction (or both)), signs of failure (pain, swelling, mobility, percussion pain, internal root resorption, and furcation or periapical bone destruction (or both)), internal root resorption, pulp canal obliteration, tenderness to percussion, inter‐radicular bone destruction, physiological root resorption: evaluation at 6, 12 and 24 months (at tooth level)

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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: "the children were examined clinically by 3 experienced pediatric dentists (not the operators) blinded to the technique"

Blinding of radiological outcomes assessment

Low risk

Quote: "the children were examined radiographically by 3 experienced pediatric dentists (not the operators) blinded to the technique"

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

Fallahinejad Ghajari 2013

Methods

RCT, split‐mouth

Teeth randomly assigned

Setting not mentioned. Conducted in Iran. One operator (no detail)

Participants

21 children, 42 teeth, mean age 6.9 ± 0.7, age range 5 to 8 years

Interventions

Group 1: Direct pulp capping (MTA); n = 21 (1 visit)

  • cotton rolls and suction

  • Caries removal prior to pulpal access

  • high speed and carbide round bur

  • For haemostasis, dry cotton pellet

  • Irrigation with saline

  • ProRoot MTA before being restored with amalgam

Group 2: Direct pulp capping (CEM); n = 21 (1 visit)

  • cotton rolls and suction

  • Caries removal prior to pulpal access

  • high speed and carbide round bur

  • For haemostasis, dry cotton pellet

  • Irrigation with saline

  • CEM before being restored with amalgam

Outcomes

Clinical failure (pain, swelling, tenderness to pressure, sinus tract, swelling and tenderness to percussion), radiological failure (internal and/or external root resorption, interradicular radiolucencies, and periapical lesions): evaluation at 6 and 20 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

The single operator and children were blind to biomaterial/treatment

Blinding of clinical outcomes assessment

Low risk

Quote: "Treatment outcomes ...were evaluated at 20 months by a calibrated dentist, radiologist and a statistician who were also blind to the type of used biomaterial"

Blinding of radiological outcomes assessment

Low risk

Quote: "Treatment outcomes ...were evaluated at 20 months by a calibrated dentist, radiologist and a statistician who were also blind to the type of used biomaterial"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Farsi 2005

Methods

RCT, parallel‐arm

Children randomly assigned

Setting not mentioned. Operators were paediatric dentists. Conducted in Saudi Arabia

Participants

100 children, 120 teeth, mean age 6 years, standard deviation age 1.6 years, age range 3 to 8 years

Interventions

Group 1: Pulpotomy (formocresol); n = 60 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • For haemostasis, damp sterile cotton pellet

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE and IRM before being restored with stainless‐steel crowns

Group 2: Pulpotomy (MTA); n = 60 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • For haemostasis, damp sterile cotton pellet

  • No irrigation

  • MTA (3:1 powder:saline ratio) applied after pulpotomy, followed by IRM before being restored with stainless‐steel crowns

Outcomes

Clinical success (no pain, sinus tract or swelling), radiographic success (no evidence of furcation radiolucency, internal root resorption, or periapical bone destruction), physiological root resorption, furcation radiolucency, periapical radiolucency, internal root resorption, pulp canal obliteration, pain symptoms, sinus tract, swelling: evaluation at 6, 12, 18 and 24 months (at tooth level)

Notes

Dropouts: "Out of 120 teeth, only 74 were assessed clinically and radiographically throughout the follow up period"

Comment: only the results for these 74 teeth were reported

Source of funding: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Coin toss

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Fei 1991

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Pediatric Dental Clinic at the University of Southern California School of Dentistry. Operators not mentioned

Participants

62 children, 83 teeth, mean age 6.7 years, age range 3.2 to 10.1 years

Interventions

Group 1: Pulpotomy (formocresol); n = not stated (27 teeth analysed) (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

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE and IRM before being restored with stainless‐steel crowns

Group 2: Pulpotomy (ferric sulphate); n = not stated (29 teeth analysed) (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

  • No irrigation

  • 15.5% FS solution applied after pulpotomy, followed by ZOE and IRM before being restored with stainless‐steel crowns

Outcomes

Clinical success (no symptoms of pain, tenderness to percussion, swelling, fistulation or pathological tooth mobility), radiographic success (normal periodontal ligament, absence of pathological internal root resorption, external root resorption, no intraradicular or no periapical radiolucency), signs of failure (symptoms of pain, tenderness to percussion, swelling, fistulation, pathological tooth mobility, abnormal periodontal ligament, pathological internal root resorption, external root resorption, intraradicular or periapical radiolucency), internal root resorption, pulp canal obliteration: evaluation at 3, 6 and 12 months (at tooth level)

Notes

56 teeth from 48 children were available for evaluation after 12 months (Group 1: 27; Group 2: 29)

Source of funding: not reported, although FS material was provided by a manufacturer
Quote: "The ferric sulphate tested in this study was provided by the Ultradent Company"

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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 evaluations of the teeth were conducted by two independent examiners who had no knowledge of the group to which the particular tooth was assigned"

Blinding of radiological outcomes assessment

Low risk

Quote: "Radiological evaluations of the teeth were conducted by two independent examiners who had no knowledge of the group to which the particular tooth was assigned"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Number of randomised teeth unknown

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Fernandes 2015

Methods

RCT, parallel‐arm

Children randomly assigned

Setting not mentioned. Operators not mentioned. Conducted in Brazil

Participants

number of children not mentioned, 60 teeth, mean age 6.5 years, age range 5 to 9 years

Interventions

Group 1: Pulpotomy (formocresol); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, dry sterile cotton pellet

  • Irrigation with saline

  • Cotton wool pellet soaked with 1:5 FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE and IRM before being restored with glass ionomer cement

Group 2: Pulpotomy (CH); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, dry sterile cotton pellet

  • Irrigation with saline

  • CH, followed by ZOE and IRM before being restored with glass ionomer cement

Group 3: Pulpotomy (LLLT); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, dry sterile cotton pellet

  • Irrigation with saline

  • the InGaAlP laser radiation was delivered through a 320 lm diameter optical fibre in contact with pulp tissue; the parameters were set at 660 nm wavelength, 10 mW power output, 2.5 J/cm² energy density, 50 to 60 Hz frequency, 0.04 cm² focus beam diameter and irradiation time of 10 seconds, followed by ZOE and IRM before being restored with glass ionomer cement

Group 4: Pulpotomy (CH+ LLLT); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, dry sterile cotton pellet

  • Irrigation with saline

  • the InGaAlP laser radiation was delivered through a 320 lm diameter optical fibre in contact with pulp tissue; the parameters were set at 660 nm wavelength, 10 mW power output, 2.5 J/cm² energy density, 50 to 60 Hz frequency, 0.04 cm² focus beam diameter and irradiation time of 10 seconds, followed by CH, then IRM before being restored with glass ionomer cement

Outcomes

Clinical success (absence of spontaneous pain, mobility, swelling, or fistula), Radiographic success (presence of hard tissue barrier formation and pulp calcifications, and absence of internal or external root resorption and furcation radiolucency)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random number table

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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: "At each checkup, two blinded and calibrated investigators performed clinical and periapical radiographic examination of the pulpotomized teeth"

Blinding of radiological outcomes assessment

Low risk

quote: "At each checkup, two blinded and calibrated investigators performed clinical and periapical radiographic examination of the pulpotomized teeth"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Fernández 2013

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Paediatric Dentistry at the Universitat Internacional de Catalunya. Operators were student and dentists.

Participants

81 children, 100 teeth, mean age 6.7 ± 1.6 years, age range 3.2 to 10.1 years

Interventions

Group 1: Pulpotomy (formocresol); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur the slow‐speed bur

  • Pulpotomy amputation with slow‐speed bur

  • For haemostasis, moist cotton pellet with saline

  • Irrigation not mentioned

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by IRM before being restored with stainless‐steel crowns

Group 2: Pulpotomy (MTA); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur the slow‐speed bur

  • Pulpotomy amputation with slow‐speed bur

  • For haemostasis, moist cotton pellet with saline

  • Irrigation not mentioned

  • MTA paste obtained by mixing MTA powder with sterile saline in a ratio of 3 : 1, followed by IRM before being restored with stainless‐steel crowns

Group 3: Pulpotomy (ferric sulphate); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur the slow‐speed bur

  • Pulpotomy amputation with slow‐speed bur

  • For haemostasis, moist cotton pellet with saline

  • Irrigation not mentioned

  • 20% FS solution applied after pulpotomy for 15 seconds with syringe applicator (then solution was rinsed off with water, verifying that no blood clot was present before restoration), followed by IRM before being restored with stainless‐steel crowns

Group 4: Pulpotomy (sodium hypochlorite); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur the slow‐speed bur

  • Pulpotomy amputation with slow‐speed bur

  • For haemostasis, moist cotton pellet with saline

  • Irrigation not mentioned

  • cotton pellet saturated in 5% NaOCl was placed over the remaining pulp tissue for 30 seconds (then the solution was rinsed off with water, verifying that no blood clot was present before restoration), followed by IRM before being restored with stainless‐steel crowns

Outcomes

Clinical success (no pain, swelling, fistulation, or pathologic mobility), radiographic success (no evidence of internal or external resorption, or periradicular radiolucency), overall success: evaluation at 6, 12, 18, and 24 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random number table

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Low risk

Quote: "the radiographs were ...re‐evaluated independently by two blinded observers"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

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

Fuks 1997

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the paediatric dentistry undergraduate student's clinic of the Hebrew University‐Hadassah School of Dental Medicine, Israel Operators were the Israeli authors of this study

Participants

72 children, 96 teeth, mean age 7.5 years, age range 4.5 to 10 years

Interventions

Group 1: Pulpotomy (formocresol); n = 38 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with slow‐speed bur

  • For haemostasis, moistened cotton pellet with saline

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE and IRM before being restored with stainless‐steel crowns

Group 2: Pulpotomy (ferric sulphate); n = 58 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with slow‐speed bur

  • For haemostasis, moistened cotton pellet with saline

  • No irrigation

  • 15.5% FS solution applied after pulpotomy for 10 or 15 seconds. The FS was then flushed from the pulp chamber with a copious amount of water, followed by ZOE and IRM before being restored with stainless‐steel crowns

Outcomes

Radiographic success (internal root resorption, furcation radiolucency or periapical bone destruction), furcal radiolucency, periapical radiolucency, internal root resorption, pulp canal obliteration, faster root resorption compared with contralateral, slower root resorption compared with contralateral, similar root resorption compared with contralateral: evaluation at 20.5: (6 to 11), (12 to 23) and (24 to 35) months (at tooth level)

Signs of failure (internal root resorption, furcation radiolucency, periapical bone destruction, pain, swelling, or sinus tract): evaluation at 20.5 (24 to 35) months (at tooth level)

Notes

Source of funding: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Coin toss

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Garrocho‐Rangel 2009

Methods

RCT, split‐mouth

Teeth randomly assigned

Pediatric Dentistry Postgraduate Program, Faculty of Dentistry of San Luis Potosi University, Mexico. A single operator performed all procedures

Participants

45 children, 90 teeth, median age (± standard deviation) boys: 6.4 ± 1.16 years, girls: 5.7 ± 1.01 years

Interventions

Group 1: Direct pulp capping (EMD); n = 45 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • No pulpotomy amputation

  • For haemostasis, no detail, "during 2 or 3 minutes"

  • Alternating irrigations of sterile saline and chlorhexidine solution and dried gently with sterile cotton pellet

  • Direct pulp capping. EMD was placed, cavity was sealed with dentine adhesive, before being restored with glass‐ionomer cement and stainless‐steel crown

Group 2: Direct pulp capping (calcium hydroxide); n = 45 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • No pulpotomy amputation

  • For haemostasis, no detail, "during 2 or 3 minutes"

  • Alternating irrigations of sterile saline and chlorhexidine solution and dried gently with sterile cotton pellet

  • Direct pulp capping. CH was placed, cavity was sealed with dentine adhesive, before being restored with glass‐ionomer cement and stainless‐steel crown

Outcomes

Signs of failure (internal dentin resorption, spontaneous pain, gingival abscess (sinus tract), external root resorption or pathological mobility), internal dentin resorption, spontaneous pain, abscess, pathological root resorption, swelling or pathological mobility; evaluation at 1, 6 and 12 months (at tooth level)

Notes

Source of funding: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random using number sequences generated by R 2.4.0 software

Allocation concealment (selection bias)

Low risk

Quote: "The operator was blind to the random number schemes until just before placing the materials"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "The participants…were blind regarding capping material group assignation"

Blinding of clinical outcomes assessment

Low risk

Quote: "Assessing observer and analyst were blind regarding capping material group assignation"

Blinding of radiological outcomes assessment

Low risk

Quote: "Assessing observer and analyst were blind regarding capping material group assignation"

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

Goyal 2014

Methods

RCT, parallel arm

Teeth randomly assigned

Setting not mentioned. Conducted in India. Operator not mentioned

Participants

41 children, 45 teeth, age range 4 to 8 years

Interventions

Group 1: Pulpotomy (full strength formocresol); n = 15 (2 visits)

  • No details

  • A number 1 foam pellet saturated with FC then twice squeezed to remove excess FC and placed for 5 minutes. Then teeth restored with stainless‐steel crown (second visit)

Group 2: Pulpotomy (1:5 diluted formocresol); n = 15 (2 visits)

  • No details

  • 1:5 diluted FC thoroughly mixing 3 mL glycerine with 1 mL distilled water; 4 mL of the diluent is then added to the 1 mL of the FC. A number 1 foam pellet saturated with 1:5 diluted FC then twice squeezed to remove excess 1:5 diluted FC and placed for 5 minutes. Then teeth restored with stainless‐steel crown (second visit)

Group 3: Pulpotomy (1:25 diluted formocresol); n = 15 (2 visits)

No details

1:25 diluted FC: 18 mL glycerine and 6 mL distilled water are thoroughly mixed and to which 1 part of FC is added. A number 1 foam pellet saturated with 1:25 diluted FC then twice squeezed to remove excess 1:25 diluted FC and placed for 5 minutes. Then teeth restored with stainless‐steel crown (second visit)

Outcomes

Clinical failure (pain, intra‐oral/extra‐oral swelling, tenderness on percussion, sinus/fistula), radiological failure (furcation radiolucency, periapical changes, internal/external resorption): evaluation at 1, 3, 6 and 9 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Quote: "the subjects were unaware of their group"

Insufficient information to make a clear judgement for blinding of personnel

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned at 9 months

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Goyal 2016

Methods

RCT, parallel arm

Teeth randomly assigned

DAV Dental College Yamuna Nagar, Haryana. A single operator (investigator) performed all procedures

Participants

42 children, 90 teeth, 4 to 8 years

Interventions

Group 1: Pulpotomy (15.5% ferric sulphate); n = 30 (2 visits)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation not mentioned

  • For haemostasis, no detail

  • Irrigations with saline

  • Sterile cotton pellet no.4 moistened with 15.5% ferric sulphate placed in contact with the radicular pulp for 15 s. before being restored with ZOE and stainless‐steel crown

Group 2: Pulpotomy (2% buffered glutaraldehyde); n = 30 (2 visits)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation not mentioned

  • For haemostasis, no detail

  • Irrigations with saline

  • A sterile cotton pellet no. 4 moistened in 2% buffered glutaraldehyde solution (2% glutaraldehyde in 1 with a solution activator of 6.5 g Bioclenz‑G) placed on amputated pulp stumps for 5 min before being restored with ZOE and stainless‐steel crown

Group 3: Pulpotomy (MTA); n = 30 (2 visits)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation not mentioned

  • For haemostasis, no detail

  • Irrigations with saline

  • MTA paste (prepared by mixing MTA powder with sterile saline at a 3:1 powder/saline ratio to obtain a thick, creamy consistency) placed on the floor of the pulp chamber and condensed against the pulp orifices with a moist cotton pellet, before being restored with ZOE and stainless‐steel crown

Outcomes

Clinical parameters (pain, sinus formation, swelling (intra oral), and mobility), radiological parameters (PDL widening, internal resorption, external resorption, periapical radiolucency, canal obliteration, and furcation radiolucency): evaluation at 24 h, 1 month, 3 months and 6 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Grewal 2016

Methods

RCT, split‐mouth

Children randomly assigned

Conducted at the Outpatient Department of Paediatric Dentistry, Punjab Government Dental College and Hospital, Amritsar, Punjab, India. Operators not mentioned.

Participants

20 children, 40 teeth, mean age 7.35 years, age range 5 to 10 years

Interventions

Group 1: Pulpotomy (Biodentine); n = 20 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with round burs no. ½ and ¼ or excavator

  • For haemostasis, dry sterile cotton pellet

  • Irrigation with saline

  • Before the capsule was opened, it was tapped gently on a hard surface to diffuse the powder. Five drops of liquid from the single‐dose dispenser were poured into the capsule, after which the latter was placed in a triturator for 30 s. The material was then transferred with the aid of the manufacturer supplied spatula and placed inside the cavity with the aid of an amalgam carrier or spatula. To adjust it against the walls without excessive compression a plugger or sterile cotton pellet was used. The entire cavity was filled with Ca3SiO5 till the second appointment. After 24/48h, leaving half depth of the cavity with Ca3SiO5 material without any voids or lack of marginal adaptation checked under a surgical operating microscope, the final restoration was done with nanohybrid composite resin

Group 2: Pulpotomy (CH); n = 20 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with round burs no. ½ and ¼ or excavator

  • For haemostasis, dry sterile cotton pellet

  • Irrigation with saline

  • CH paste was gently applied with the help of disposable tip topped by light cured CH, and the cavity was restored with glass ionomer cement. In the recall visit after 24 to 48 h, after removing top layer of GIC up to half of cavity depth, teeth were restored with nanohybrid composite resin

Outcomes

Pain, swelling: evaluation at 3, 6 and 12 months; mean dentin thickness, internal root resorption: evaluation at 6 and 12 months; colour matching, marginal discolouration, secondary caries, anatomic form, surface texture, marginal integrity, pulp sensitivity: evaluation at 12 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computerised random‐number

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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: "Blinded clinical and radiographic outcomes were observed"

Blinding of radiological outcomes assessment

Low risk

Quote: "Blinded clinical and radiographic outcomes were observed"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Gupta 2015

Methods

RCT, parallel arm

Teeth randomly assigned

Outpatient Department of Pediatric Dentistry of Subharti Dental College, Meerut. A single operator (investigator) performed all procedures

Participants

30 children, 30 teeth, 4 to 10 years

Interventions

Group 1: Pulpotomy (ferric sulphate); n = 10 (1 visit)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation with low speed bur and excavator

  • For haemostasis, moist cotton pellets

  • Irrigations with saline

  • Sterile cotton pellet moistened with ferric sulphate placed in contact with the radicular pulp for 15 s. before being restored with ZOE and stainless‐steel crown

Group 2: Pulpotomy (electrosurgery); n = 10 (1 visit)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation not mentioned

  • For haemostasis, no detail

  • Irrigations with saline

  • an electrode tip of the ES unit T4 (fine wire) with 50 W power, 110 V ± 5% 50/60 Hz 92 VA and work frequency of 1.5 ˜ 1.7 MHz ± 5% was used for the pulpotomy procedure. During the procedure, the electrode tip was positioned slightly above the pulp tissue but close enough for electrical arcing to occur (about 1 mm above the tissue). The current was applied for 1 to 2 seconds over each pulpal stump. This procedure was repeated up to three times on each pulpal orifice, until brown appearance was observed in the tissue. Then teeth were restored with ZOE and stainless‐steel crown

Group 3: Pulpotomy (diode laser); n = 10 (1 visit)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation not mentioned

  • For haemostasis, no detail

  • Irrigations with saline

  • the pulp was ablated to the level of the canal orifice using diode laser with 980 nm wavelength, 3 W of power and on continuous pulse mode. The laser energy of 4.0 J/cm² was delivered through a 0·5 mm diameter optical fibre in contact with pulp tissue with the total energy of one spot, corresponding to 2 minutes and 31 seconds exposure. If additional ablation was required, subsequent multiple applications were administered.Then teeth were restored with ZOE and stainless‐steel crown

Outcomes

Clinical success, radiological success, pain, furcal and periapical radiolucency, internal root resorption: evaluation at 3, 6, 9 and 12 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

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

Haghgoo 2009

Methods

RCT, parallel‐arm

Teeth randomly assigned

Participants

70 teeth, age range 4 to 7 years

Interventions

Group 1: Pulpotomy (formocresol); n = 35 (1 visit)

Group 2: Pulpotomy (Iranian Root MTA); n = 35 (1 visit)

Outcomes

Clinical failure, radiological failure, pain, soft tissue pathology, pathological radiolucency, pathological root resorption: evaluation at 12 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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

The clinical ...follow up evaluations were performed at 6, 12 months by a blinded dentist

Blinding of radiological outcomes assessment

Low risk

The ...radiographic follow up evaluations were performed at 6, 12 months by a blinded dentist

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

Holan 2005

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Pediatric Dentistry Clinic of the Hebrew University‐Hadassah School of Dental Medicine in Jerusalem, Israel. Operators were the authors of this study

Participants

35 children, 64 teeth, mean age 6.5 years, age range 4.4 to 11 years

Interventions

Group 1: Pulpotomy (formocresol); n = 31 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • Haemostasis not mentioned

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE and IRM before being restored with composite or stainless‐steel crowns

Group 2: Pulpotomy (MTA); n = 33 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • Haemostasis not mentioned

  • No irrigation

  • MTA (3:1 powder:saline ratio) applied after pulpotomy, followed by IRM before being restored with composite, amalgam or stainless‐steel crowns

Outcomes

Signs of failure (furcation radiolucency, periapical bone destruction, internal root resorption, swelling or sinus tract), abscess, pulp canal obliteration, dentine bridge formation, furcal radiolucency, periapical radiolucency, internal root resorption, external root resorption, calcific metamorphosis (periapical radiolucency or inter‐radicular radiolucency): evaluation at 36 (range 4 to 74) months (at tooth level)

Notes

Reasons of dropouts: "Of the 64 pulpotomized teeth, 62 teeth in 33 children were available for analysis of success/failure rate. 2 molars in 2 patients, both of the FC group, were excluded from the study because the patients never returned for follow‐up examination"

Comment: quotes: "when a patient did not respond or broke an appointment, further attempts were made to call the parents and a follow‐up examination was rescheduled"; "the follow‐up period was defined as the time elapsed between treatment and one of the following: 1/detection of pulpotomy failure; 2/naturally exfoliated tooth; 3/patient's last visit for recall examination. Teeth with less than 12 months follow‐up time were excluded from the study, unless a failure was detected during the first postoperative year"

Source of funding: not reported, although the MTA material was provided by a colleague at another university in the USA

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Coin toss

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

High risk

Quote: "the children were then examined clinically by 1 of the 3 authors who were not blind to which treatment group the assessed tooth belonged"

Blinding of radiological outcomes assessment

Low risk

Quote: "All 3 authors blindly evaluated the radiographs"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Huth 2005

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Pedodontic Section, Department of Restorative Dentistry and Periodontology, Ludwig‐Maximilians‐University, Munich, Germany. Operators were 2 paedodontists

Participants

107 children, 191 teeth, mean age 4.8 years, standard deviation age 1.6 years, age range 2 to 8 years

Interventions

Group 1: Pulpotomy (formocresol); n = 50 (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, moistened cotton pellet with saline

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by IRM before being restored with glass‐ionomer cement and composite or stainless‐steel crowns

Group 2: Pulpotomy (Er:YAG); n = 47 (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, moistened cotton pellet with saline

  • No irrigation

  • Er:YAG laser: 2 Hz and 180 mJ/pulse without water cooling. Mean (± standard deviation) number of laser pulses per tooth: 31.5 ± 5.9 equally distributed to each pulp. Followed by IRM before being restored with glass‐ionomer cement and composite or stainless‐steel crowns

Group 3: Pulpotomy (calcium hydroxide); n = 44 (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, moistened cotton pellet with saline

  • No irrigation

  • CH placed after pulpotomy for 15 seconds, followed by IRM before being restored with glass‐ionomer cement and composite or stainless‐steel crowns

Group 4: Pulpotomy (ferric sulphate); n = 50 (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, moistened cotton pellet with saline

  • No irrigation

  • 15.5% FS solution after pulpotomy, followed by IRM before being restored with glass‐ionomer cement and composite or stainless‐steel crowns

Outcomes

Clinical failure (spontaneous pain, tenderness to percussion, fistula, soft tissue swelling, and pathological tooth mobility), spontaneous pain, tenderness to percussion, swelling, fistula, pathological mobility: evaluation at 6, 12, 18 and 24 months

Radiological failure (periapical or furcal radiolucency, pathological external or distinct internal root resorption, or widened periodontal ligament space), signs of failure (spontaneous pain, tenderness to percussion, fistula, soft tissue swelling, pathological tooth mobility, periapical or furcal radiolucency, pathological external or distinct internal root resorption, or widened periodontal ligament space), furcal radiolucency, periapical radiolucency, internal root resorption, external root resorption, periodontal ligament widening: evaluation at 12 and 24 months (at tooth level)

Notes

Reasons of dropouts: "103 patients (191 teeth followed up): 3 teeth from the laser group and 6 from the calcium hydroxide group were excluded from follow‐up and statistical analysis, due to uncontrollable bleeding during radiation or placement of calcium hydroxide, since a hyperemic, inflamed radicular pulp is considered a contraindication for vital pulpotomy"; "12 teeth had exfoliated physiologically"

Comment: quotes: "4 patients moved away"

Source of funding: quote: "The study was completely financed by Departmental funding". (Department of Restorative Dentistry & Periodontology, Dental School, Ludwig‐Maximilians‐University, Munich)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "...by an assistant casting a concealed lot from a box containing 4 x 50 lots (block randomization)"

Allocation concealment (selection bias)

Low risk

Quote: "...all other contributors for the study were blinded to generation and implementation of the treatment assignment"

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 re‐evaluations …were performed independently by two experienced dentists (not the operators) blinded to the technique"; "the outcome assessment and data analysis were blinded, since the techniques were indistinguishable and coded"

Blinding of radiological outcomes assessment

Low risk

Quote: "radiographic examinations were performed independently by two experienced dentists (not the operators) blinded to the technique"; "the outcome assessment and data analysis were blinded, since the techniques were indistinguishable and coded"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Ibricevic 2000

Methods

RCT, parallel‐arm

Children randomly assigned

Setting not mentioned. Conducted in Kuwait. Operator was 1 senior paedodontist

Participants

70 children, 164 teeth, mean age 4.3 years, age range 3 to 6 years

Interventions

Group 1: Pulpotomy (formocresol); n = 80 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with high‐speed bur

  • For haemostasis, dry cotton pellet

  • Irrigation with saline

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE before being restored with amalgam or stainless‐steel crowns

Group 2: Pulpotomy (ferric sulphate); n = 84 (1 or 2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with high‐speed bur

  • For haemostasis, dry cotton pellet

  • Irrigation with saline

  • 15.5% FS solution after pulpotomy for 15 seconds, followed by ZOE. For very uncooperative children, over the ZOE paste, IRM was placed for 5 days and then restoration with amalgam or stainless‐steel crown

Outcomes

Clinical success (absence of any fistula, abscess, swelling, spontaneous pain or pathological mobility), radiological failure (normal periodontal ligament space, no pathological internal or external root resorption and no intraradicular or periapical radiolucency), internal root resorption, periapical bone destruction, inter‐radicular bone destruction, succedaneous tooth structural anomaly: evaluation at 3 to 20 and 46 to 48 months (at tooth level)

Signs of failure (internal root resorption, furcation radiolucency, periapical bone destruction, or a combination): evaluation at 46 to 48 months (at tooth level)

Notes

The first 70 teeth were all treated within 1 month. The pulpotomy therapy of a further 124 primary molars was performed on the same children, during the following 6 months. On the final recall after 42 to 48 months, only 60 children appeared within the 4 months' recall period

Clinical follow‐up: every 3 months

Radiographic follow‐up: 6, 20 and 42 to 48 months

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Alternate allocation

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

High risk

Quote: "The clinical follow‐up by the same examiner who had performed all pulpotomies and was aware to which treatment groups the subjects belonged"

Blinding of radiological outcomes assessment

Low risk

Quote: "Both authors, blindly, evaluated radiographs"

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

Jayam 2014

Methods

RCT, parallel‐arm

Children randomly assigned

Conducted at the outpatient department, Dr R Ahmed Dental College and Hospital, India. Operators not mentioned.

Participants

66 children, 100 teeth, age range 3 to 7 years

Interventions

Group 1: Pulpotomy (MTA); n = 50 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access with no precision

  • Pulpotomy amputation with excavator

  • For haemostasis, no precision

  • Irrigation not mentioned

  • MTA 3:1 ratio, sandy consistency, applied over pulpal orifices, followed by placement of moistened cotton pellet over MTA for 15 min, followed by ZOE, stainless steel crown and/or glass ionomer restoration and silver amalgam

Group 2: Pulpotomy (FC); n = 50 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access with no precision

  • Pulpotomy amputation with excavator

  • For haemostasis, no precision

  • Irrigation not mentioned

  • dampened cotton pellet was placed over pulp stumps for 5 min, followed by ZOE, stainless steel crown and/or glass ionomer restoration and silver amalgam

Outcomes

Clinical failure (history of pain, tenderness to palpation/percussion, pathological mobility, intra‐ or extra‐oral swelling, intra‐ or extra‐oral sinus, radiograph evaluation (integrity of lamina dura, presence or absence of radiolucencies in the apical or bifurcation areas of tooth, pathological internal or external root resorption, pulp canal obliteration), dentin bridge formation, overall success: evaluation at 1, 3, 6, 12 and 24 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Kalra 2017

Methods

RCT, parallel‐arm

Children randomly assigned

Conducted in India. Setting and operators not mentioned.

Participants

48 children, 60 teeth, age range 4 to 10 years, mean 6.5 ± 1.2 years

Interventions

Group 1: Pulpotomy (MTA); n = 30 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with No. 557 round bur

  • Pulpotomy amputation with excavator

  • For haemostasis, cotton pellet moistened in saline

  • Irrigation with saline

  • MTA powder mixed with distilled water as per manufacturer’s instructions into a thick paste and was placed onto the pulp stump, followed by glass ionomer cement before being restored with stainless steel crown

Group 2: Pulpotomy (Aloe vera); n = 30 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with No. 557 round bur

  • Pulpotomy amputation with excavator

  • For haemostasis, cotton pellet moistened in saline

  • Irrigation with saline

  • A healthy plant of pure A barbadensis Mill, approximately 4 years old,[10] certified by the Indian Agricultural Research Institute, New Delhi, India, was procured at regular intervals from this institute throughout the study period. From the whole plant, a healthy leaf was selected and cut from its stem base, cleaned with 70% ethyl alcohol, and stored in distilled water for 1 h to eliminate aloin. After 1 h, with the help of a sterile Bard‑Parker blade, the outer green rind portion was removed, and the knife was introduced inside the inner mucilage layer. The mucilage or the inner clear jelly‑like substance, approximately 10 mm, was removed and washed again. The mucilage was cut half and placed onto the pulp stumps of the tooth. The aloe vera gel was further covered with a layer of collagen sponge followed by placement of glass ionomer cement restoration, before being restored with stainless steel crown

Outcomes

Clinical failure (ain, tenderness, mobility, swelling, sinus), radiographic failure (widening of periodontal ligament space, radiolucency, root resorption, pulp obliteration): evaluation at 1, 3, 6, 9, and 12 months

Notes

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

Quote: "...the parent selecting a color‑coded stick out from an opaque bag mentioning the medicament"

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Kang 2015

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Pediatric Dentistry at the Yonsei University Dental Hospital. Operators were seven paediatric dentists

Participants

102 children, 151 teeth, age range 3 to 10 years

Interventions

Group 1: Pulpotomy (RetroMTA); n = 49 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with a round carbide bur

  • Pulpotomy amputation with high‐speed then slow speed bur

  • For haemostasis, cotton pellets wet by sterile saline

  • Irrigation with saline

  • filled with a resin‐modified glass ionomer cement after waiting 5 min for the MTA material to set and restored with a stainless‐steel crown at the first visit.

Group 2: Pulpotomy (OrthoMTA); n = 47 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with a round carbide bur

  • Pulpotomy amputation with high‐speed then slow speed bur

  • For haemostasis, cotton pellets wet by sterile saline

  • Irrigation with saline

  • wet cotton pellet and temporary filling with Caviton over the MTA materials. On the second visit, which took place within 3 weeks of the first visit, the teeth were filled with a resin‐modified glass ionomer cement and restored with a

  • stainless‐steel crown

Group 3: Pulpotomy (ProRoot MTA); n = 47 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with a round carbide bur

  • Pulpotomy amputation with high‐speed then slow speed bur

  • For haemostasis, cotton pellets wet by sterile saline

  • Irrigation with saline

  • wet cotton pellet and temporary filling with Caviton over the MTA materials. On the second visit, which took place within 3 weeks of the first visit, the teeth were filled with a resin‐modified glass ionomer cement and restored with a stainless‐steel crown

Outcomes

Clinical failure (spontaneous pain and/or sensitivity to palpation/percussion; fistula, gingival redness, and swelling and/or mobility), radiological failure (bone resorption at the periapical and/or interradicular regions; PDL space widening; and external/internal root resorption): evaluation at 3, 6 and 12 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Table of random numbers

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Low risk

Quote: "...one dental radiologist (KT Kim) who were not involved in this study were blinded to the group assignment and treatment and performed all radiographic follow‐up examinations after the completion of the 12‐month study period."

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Khorakian 2014

Methods

RCT, split‐mouth

Teeth randomly assigned

Conducted in the paediatric department of Mashhad Dental School, Iran. Operator was a postgraduate student of paediatric dentistry, who was supervised by two academic staff

Participants

51 children, 102 teeth, age range 4 to 6 years

Interventions

Group 1: Pulpotomy (CEM); n = 51 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with a high speed bur

  • Pulpotomy amputation with slow speed bur

  • For haemostasis, cotton pellets wet by sterile saline

  • Irrigation not mentioned

  • a 2 mm layer of CEM cement (BioniqueDent, Tehran, Iran) was applied directly over the radicular pulp. CEM was prepared using a 3 to 1 powder to liquid ratio, before being restored with stainless steel crown

Group 2: Pulpotomy (ES/ZOE); n = 51 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with a high speed bur

  • Pulpotomy amputation with slow speed bur

  • For haemostasis, cotton pellets wet by sterile saline

  • Irrigation not mentioned

  • ES ball‐shaped electrode was immediately used for tissue coagulation. The unit was set at 55 W, 3.69 MHz, 600 ohm, and COAG mode. The electrode was placed 1 to 2 mm above the pulp orifices and then electrical arc allowed to bridge for 1 s. This procedure was repeated up to three times on each pulpal orifice with 5 to 10 s cool‐down intervals, until a dark brown appearance was observed in the tissues. After copious irrigation, zinc oxide eugenol was placed directly on the radicular pulp stump, before being restored with stainless steel crown

Outcomes

Clinical success (lack of pain, mobility, swelling, sinus tract, tenderness to percussion and bone swelling), radiographic success (PDL and periapical regions with normal width and trabeculation minimal internal resorption), pulp canal obliteration: evaluation at 6, 12 and 24 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computerised random‐number

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "...both the patients and outcome assessors were blinded to the type of treatment"

Blinding of clinical outcomes assessment

Low risk

Quote: "...both the patients and outcome assessors were blinded to the type of treatment"

Blinding of radiological outcomes assessment

Low risk

Quote: "...both the patients and outcome assessors were blinded to the type of treatment"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Kusum 2015

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Pediatric and Preventive Dentistry, Faculty of Dental Sciences, King George’s Medical University, UP, Lucknow. Operator not mentioned.

Participants

90 children, 90 teeth, mean age 6.8 years, age range 3 to 10 years

Interventions

Group 1: Pulpotomy (MTA); n = 25 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet with distilled water

  • Irrigation not mentioned

  • MTA: putty‐like consistency, condensed lightly with a moistened sterile cotton pellet to ensure a thickness of 2 to 3 mm, followed by ZOE before being restored with glass ionomer then stainless‐steel crowns (second visit)

Group 2: Pulpotomy (Biodentine); n = 25 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet with distilled water

  • Irrigation not mentioned

  • Biodentine: obtained by mixing pre‐measured unit dose capsules for 30 seconds at 4200 rpm in a triturator to obtain putty‐like consistency, then carried with an amalgam carrier and condensed lightly with a metal condenser on the pulp stumps, in a thickness of 2 to 3 mm, followed by ZOE before being restored with glass ionomer then stainless‐steel crowns (second visit)

Group 3: Pulpotomy (propolis); n = 25 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet with distilled water

  • Irrigation not mentioned

  • 1.5 g standardised propolis extract powder at 100% was mixed with 1.75 mL polyethylene glycol to form a thick consistency on a clean dry glass slab with a metal spatula, then the paste was carried to the pulp stumps with a metal carrier and then condensed lightly to a thickness of 2 to 3 mm, followed by ZOE before being restored with glass ionomer then stainless‐steel crowns (second visit)

Outcomes

Clinical and radiographic criteria for assessing teeth were explained along with a calibration process to the two observers on three initial cases. The criteria, based on Zurn and Seale has been used for scoring the clinical and radiographic findings. The scoring system was devised to represent severity of changes but not to define an individual tooth as a ‘success’ or ‘failure’, i.e. as the score gets larger, the pathologies get progressively more invasive and require more frequent follow‐up. Teeth scored as 1 or 2 were considered successful. Evaluation at 3, 6 and 9 months.

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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: "The teeth were evaluated clinically and radiographically by two observers independently who were blinded to the treatment type"

Blinding of radiological outcomes assessment

Low risk

Quote: "The teeth were evaluated clinically and radiographically by two observers independently who were blinded to the treatment type"

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

Liu 2011

Methods

RCT, split‐mouth

Teeth randomly assigned

Conducted at the Department of Pediatric dentistry, Pekin. Operator not mentioned.

Participants

18 children, 40 teeth, age range 4 to 9 years

Interventions

Group 1: Pulpotomy (MTA); n = 25 (1 visit)

  • Isolation not mentioned

  • Caries removal prior to pulpal access

  • Pulp access with no precision

  • Pulpotomy amputation not mentioned

  • For haemostasis, moistened cotton pellet with saline

  • Irrigation not mentioned

  • MTA followed by glass ionomer before being restored with resin composite

Group 2: Pulpotomy (CH); n = 25 (1 visit)

  • Isolation not mentioned

  • Caries removal prior to pulpal access

  • Pulp access with no precision

  • Pulpotomy amputation not mentioned

  • For haemostasis, moistened cotton pellet with saline

  • Irrigation not mentioned

  • CH followed by glass ionomer before being restored with resin composite

Outcomes

Clinical success (no pain, swelling, fistula, tenderness to percussion, pathologic mobility), radiologic success (no periapical or interradicular radiolucency, pathological root resorption): evaluation at 10 to 56 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Lourenço 2015a

Methods

RCT, parallel arm

Teeth randomly assigned

Setting and operators not mentioned

Participants

22 children, 30 teeth, mean age 6.6 years, standard deviation age 1.4 years.

Interventions

Group 1: Pulpotomy (Portland cement, PC); n = 10 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed and round carbide bur

  • Pulpotomy amputation with excavator

  • Irrigation with saline

  • For haemostasis, dry sterile cotton pellet

  • PC applied after pulpotomy, followed by IRM before being restored with resin glass ionomer

Group 2: Pulpotomy (PC + iodoform, PC + CHI); n = 10 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed and round carbide bur

  • Pulpotomy amputation with excavator

  • Irrigation with saline

  • For haemostasis, dry sterile cotton pellet

  • PC + CHI₃ (20% radiopacifier, 80% PC) applied after pulpotomy, followed by IRM before being restored with resin glass ionomer

Group 3: Pulpotomy (PC + zirconium oxide, PC + ZrO); n = 10 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed and round carbide bur

  • Pulpotomy amputation with excavator

  • Irrigation with saline

  • For haemostasis, dry sterile cotton pellet

  • PC + ZrO₂ (20% radiopacifier, 80% PC) applied after pulpotomy, followed by IRM before being restored with resin glass ionomer

Outcomes

Clinical success (no swelling, fistula, spontaneous pain, mobility), radiological success (no furcation radiolucency, internal root resorption, external root resorption): evaluation at 6, 12 and 24 months (at tooth level)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computerised random‐number generator

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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: "...at each follow‐up examination two investigators who were blinded to the identification of the medicaments ... performed clinical... examination of the pulpotomized teeth"

Blinding of radiological outcomes assessment

Low risk

quote: "...at each follow‐up examination two investigators who were blinded to the identification of the medicaments ... performed... periapical examination of the pulpotomized teeth"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Malekafzali 2011

Methods

RCT, split‐mouth

Teeth randomly assigned

Conducted in the Paediatric Dental Clinic of Shahid Beheshti dental School, Tehran, Iran. Operators not mentioned

Participants

40 children, 80 teeth, mean age 6 years, standard deviation age 0.8 years, age range 4 to 8 years

Interventions

Group 1: Pulpotomy (MTA); n = 40 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with slow‐speed bur

  • For haemostasis, moistened cotton pellet with saline

  • Irrigation with saline

  • MTA (3:1 powder:saline ratio) applied after pulpotomy, followed by IRM before being restored with amalgam or stainless‐steel crowns

Group 2: Pulpotomy (calcium enriched mixture); n = 40 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with slow‐speed bur

  • For haemostasis, moistened cotton pellet with saline

  • Irrigation with saline

  • CEM applied after pulpotomy, followed by IRM before being restored with amalgam or stainless‐steel crowns

Outcomes

Clinical failure (swelling/abscess, sinus tract, spontaneous pain, pathological mobility, or a combination), radiological failure (furcation radiolucency, periapical bone destruction, internal root resorption and pathological external root resorption), external root resorption: evaluation at 6, 12 and 24 months (at tooth level)

Notes

Source of funding: "This trial was supported by Iran National Science Foundation and Iranian Center for Endodontic Research, Shahid Beheshti Medical University, Tehran, Iran"

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)

Unclear risk

Insufficient information to make a clear judgement

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: "The children were examined clinically by a blinded paediatric dentist"

Blinding of radiological outcomes assessment

Low risk

Quote: "Radiographic evaluations were performed by a blinded oral radiologist and paedodontist"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Markovic 2005

Methods

RCT, parallel‐arm

Children randomly assigned

Conducted in the Clinic of Preventive and Pediatric Dentistry, School of Dentistry, University of Belgrade, Serbia and Montenegro. Operators were 3 paedodontists with a minimum of 5 years' clinical experience

Participants

104 children, 104 teeth, mean age 6.4 years, standard deviation age 1.1 years, age range 4 to 9 years

Interventions

Group 1: Pulpotomy (formocresol); n = 33 (1 visit)

  • Cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • Pulpotomy amputation with high‐speed bur

  • For haemostasis, dry cotton pellet

  • Irrigation with saline

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy. After removal of the FC‐soaked cotton pledget, the pulp chamber was rinsed with water using an air‐water syringe. The pulp chamber was dried with a sterile cotton pledget, followed by CH before being restored with glass‐ionomer cement as a liner and amalgam

Group 2: Pulpotomy (calcium hydroxide); n = 34 (1 visit)

  • Cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • Pulpotomy amputation with high‐speed bur

  • For haemostasis, dry cotton pellet

  • Irrigation with saline

  • CH applied after pulpotomy, before being restored with glass‐ionomer cement as a liner and amalgam

Group 3: Pulpotomy (ferric sulphate)n = 37 (1 visit)

  • Cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • Pulpotomy amputation with high‐speed bur

  • For haemostasis, dry cotton pellet

  • Irrigation with saline

  • FS (15.5%) applied to pulp stumps for 15 seconds, before being restored with glass‐ionomer cement as a liner and amalgam

Outcomes

Radiographic success (pathological changes of the alveolar bone in the apical or furcation (or both) area, visible periapical or inter‐radicular radiolucency, integrity of lamina dura, pathological internal resorption, external root resorption), spontaneous pain, abnormal mobility, tenderness to percussion, changes in the integrity of lamina dura, pathological internal resorption, external root resorption, dentine bridge formation, abscess or fistula, apical and furcal destruction: reporting at 3, 6, 12 and 18 months (at tooth level)

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

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

Moretti 2008

Methods

RCT, parallel‐arm

Teeth randomly assigned

Setting not mentioned. Conducted in Brazil. Operators were 3 authors of the article

Participants

23 children, 45 teeth, mean age 6 years, standard deviation age 0.4 years, age range 5 to 9 years

Interventions

Group 1: Pulpotomy (formocresol); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, saline solution

  • Irrigation with saline

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE and IRM before being restored with glass‐ionomer cement

Group 2: Pulpotomy (MTA); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, saline solution

  • Irrigation with saline

  • MTA (1:1 ratio powder/saline) applied after pulpotomy, followed by IRM before being restored with glass‐ionomer cement

Group 3: Pulpotomy (calcium hydroxide); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, saline solution

  • Irrigation with saline

  • CH applied after pulpotomy, followed by IRM before being restored with glass‐ionomer cement

Outcomes

Clinical success (no spontaneous pain, no mobility, no swelling, no fistula and no smell), radiographic success (no internal root resorption, no inter‐radicular bone destruction, no furcation radiolucency or dentine bridge formation), fistula, pathological mobility, inter‐radicular bone destruction, internal root resorption, dentine bridge formation: evaluation at 3, 6, 12, 18 and 24 months (at tooth level)

Notes

Dropouts: "Two children… were lost to follow‐up because they moved to another city"

Group 1: 6, 12, 18, 24 months: 1 exfoliation per month

Group 2: 18 months: 1 exfoliation

Group 3: 12 and 18 months: 1 exfoliation per month; 24 months: 3 exfoliations

Exfoliations and extractions were excluded from analysis? No information

Source of funding: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random number‐producing system

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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: "...each checkup involved a clinical examination of the pulpotomized teeth, which was performed by two blinded and previously calibrated investigators"

Blinding of radiological outcomes assessment

Low risk

Quote: "...each checkup involved a periapical radiographic examination of the pulpotomized teeth, which was performed by two blinded and previously calibrated investigators"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% of children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Mortazavi 2004

Methods

RCT, parallel‐arm

Teeth randomly assigned

Setting and operators not mentioned. Conducted in Iran

Participants

58 children, 58 teeth, mean age 5.7 years, standard deviation age 1.5 years, age range 3 to 13 years

Interventions

Group 1: Pulpectomy (ZOE); n = 32 (2 visits)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • No haemostasis

  • Irrigation with saline

  • Instrumentation with K files

  • The pulp chamber was finally dried with suitably sized cotton pellets and the pulp canals with appropriately sized pellets paper points

  • At the first visit, a complete pulpotomy was performed. An FC‐moistened cotton pledget was then placed in the pulp chamber and sealed with zonalin as temporary restoration. Then ZOE applied after pulpectomy before being restored with amalgam

Group 2: Pulpectomy (calcium hydroxide + iodoform); n = 26 (2 visits)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • No haemostasis

  • Irrigation with saline

  • Instrumentation with K files

  • The pulp chamber was finally dried with suitably sized cotton pellets and the pulp canals with appropriately sized pellets paper points

  • At the first visit, a complete pulpotomy was performed. A FC‐moistened cotton pledget was then placed in the pulp chamber and sealed with zonalin as temporary restoration. Then Vitapex (CH/iodoform) applied after pulpectomy, before being restored with amalgam

Outcomes

Signs of success (absence of pain, fistula, intraoral swelling, extraoral swelling, abnormal mobility, bone radiolucency or position and eruption pathway of the permanent successor tooth), pain symptoms, fistula, pathological mobility, extraoral swelling, intraoral swelling, bone radiolucency, position and eruption pathway of the permanent successor tooth: evaluation at 12 (range 10 to 16) months (at tooth level)

Notes

Of the 58 original children selected and treated at the beginning of the study, 52 returned for follow‐up. Six children had either moved from the area, or changed addresses or phone numbers (or both), and contact was lost

Source of funding: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random number table

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Nadkarni 2000

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Outpatient Department, Department of Pediatric Dentistry, Nair Hospital Dental College, Mumbai, India. Operators not mentioned

Participants

60 children, 70 teeth, age range 4 to 8 years

Interventions

Group 1: Pulpectomy (calcium hydroxide); n = 35 (2 visits)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access

  • Pulp access with excavator or slow‐speed bur

  • Pulpotomy amputation with excavator

  • No haemostasis

  • Irrigation with 2.5% sodium hypochlorite and saline

  • Instrumentation with barbed broaches

  • The CH was filled into the hub of the needle, the barrel threaded onto the needle and the screw post subsequently inserted. The needle was placed 2 mm short of the radiographic apex and quarter turns of the screw post expressed material into the root canal while a hand wrench was used for stabilisation of the pressure syringe system. Followed by ZOE before being restored with ZOE temporary sealing material, and at the 2nd visit with stainless‐steel crown

Group 2: Pulpectomy (ZOE); n = 35 (2 visits)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access

  • Pulp access with excavator or slow‐speed bur

  • Pulpotomy amputation with excavator

  • No haemostasis

  • Irrigation with 2.5% sodium hypochlorite and saline

  • Instrumentation with barbed broaches

  • ZOE was filled into the hub of the needle, the barrel threaded onto the needle and the screw post subsequently inserted. The needle was placed 2 mm short of the radiographic apex and quarter turns of the screw post expressed material into the root canal while a hand wrench was used for stabilisation of the pressure syringe system. Followed by ZOE before being restored with ZOE temporary sealing material, and at the second visit with stainless‐steel crown

Outcomes

Pain symptoms, tenderness to percussion, pathological mobility, pathological radiolucency: evaluation at 1, 3, 6 and 9 months (at tooth level)

Radiographic success (the radiolucency did not increase and when it was the same as the preoperative status): evaluation at 3, 6 and 9 months (at tooth level)

Clinical success (absence of pain, absence of tenderness to percussion and absence of, or decrease in mobility), signs of success (pain symptoms, tenderness to percussion, pathological mobility, pathological radiolucency): evaluation at 9 months (at tooth level)

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

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

Naik 2005

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Pedodontics and Preventive Dentistry, Mangalore, India. Operators not mentioned

Participants

38 children, 50 teeth

Interventions

Group 1: Pulpotomy (formocresol); n = 25 (2 visits)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, dry cotton pellet

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE before being restored with stainless‐steel crown after 24 hours

Group 2: Pulpotomy (MTA); n = 25 (2 visits)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, dry cotton pellet

  • No irrigation

  • MTA (3:1 powder:water ratio) applied after pulpotomy, followed by ZOE before being restored with stainless‐steel crown after 24 hours

Outcomes

Pain, mobility, swelling, sinus tract, internal root resorption, external root resorption (periapical or furcal radiolucency), root resorption in relation to contralateral tooth, pulp canal obliteration: evaluation at 1, 3 and 6 months (at tooth level)

Notes

3 teeth were not available for further follow‐up after 1 month

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Nakornchai 2010

Methods

RCT, parallel‐arm

Teeth randomly assigned

Setting not mentioned. Conducted in Thailand. 1 operator not mentioned

Participants

37 children, 50 teeth, age range 3 to 8 years

Interventions

Group 1: Pulpectomy (ciprofloxacin + metronidazole + minocycline); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, cotton pellets moistened with 10% sodium hypochlorite maintained for 1 minute

  • Irrigation with 2.5% sodium hypochlorite

  • The cavity was then dried with cotton pellets. 3Mix (ciprofloxacin + metronidazole + minocycline) applied after pulpectomy, followed by IRM dressing before glass ionomer cement and stainless‐steel crown

Group 2: Pulpectomy (calcium hydroxide + iodoform); n = 25 (1 or 2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • No haemostasis

  • Irrigation with 2.5% sodium hypochlorite

  • Instrumentation with barbed broaches

  • The canals were dried with sterile paper points. Vitapex (CH/iodoform) applied after pulpectomy, followed by IRM dressing before glass ionomer cement

  • A single visit root canal procedure was undertaken in 14 of the 25 teeth. The remaining teeth were treated in 2 visits due to great deal of gingival swelling and discharge

Outcomes

Clinical success (pain, gingival abscesses, fistula openings or abnormal mobility), radiological success (static or reduced size of bifurcation/periapical radiolucency, no progression of pathological external root resorption, no progression of internal root resorption and no newly formed radiographic lesions), spontaneous pain, tenderness to percussion, swelling, fistula, pathological mobility, abscess, furcal radiolucency, periapical radiolucency, internal root resorption, external root resorption, calcific metamorphosis: evaluation at 9 and 12 months (at tooth level)

Notes

Source of funding: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Coin toss

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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

Blinded clinical evaluations were performed by the operator

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

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

Nguyen 2017

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Hospital for Sick Children, Toronto, Canada. Operators were 5 paediatric dentists

Participants

70 children, 172 teeth, mean age 2.5 years, standard deviation age 0.5 years, min‐max 1.5 to 4 years

Interventions

Group 1: Pulpotomy (ferric sulphate); n = 100 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed, followed by slow‐speed bur

  • Pulpotomy amputation with slow speed bur

  • Haemostasis mentioned with no precision

  • No irrigation

  • A 15,5% FS on the pulp stumps with the syringe applicator for 10 to 15 seconds after pulpotomy. Then the pulp chamber was flushed with water supplied by an air‐water syringe, followed by MTA, then with a layer of light‐cured glass ionomer before being restored with acid etch resin.

Group 2: Pulpectomy (ZOE); n = 72 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed, followed by slow‐speed bur

  • Pulpotomy amputation with slow speed bur

  • Haemostasis mentioned with no precision

  • Instrumentation with files

  • The canals were then irrigated with sterile water and gently air dried using an air‐water syringe, then non‐reinforced ZOE was delivered to the root canal with a spiral paste filler inserted into the canal to a point just short of the apex, followed by a layer of light‐cured glass ionomer before being restored with acid etch resin.

Outcomes

(1) N equals incisor without pathologic change; (2) P equals pathologic change present, follow‐up recommended; and (3) Px equals pathologic change present, extract. N or Pq were considered an acceptable outcome, while incisors rated as P were considered unacceptable. + presence or absence of periapical radiolucency, pathological external root resorption, widened PDL space, physiological root resorption, internal root resorption, PCO, and dentin bridge formation, and whether the restoration was intact or not + spontaneous pain, tenderness to percussion, fistula/sinus tract, soft tissue swelling, and/or pathological tooth mobility at 12 and 18 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computerised random‐number generator

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement of Yes or No

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

No blinding of personnel providing treatment

Blinding of clinical outcomes assessment

Low risk

Quote: "A single investigator, who did not perform any pulp therapy or participate in radiographic evaluation, performed all clinical assessments."

Blinding of radiological outcomes assessment

High risk

No blinding of raters assessing radiographic outcomes

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

Niranjani 2015

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Pedodontics and Preventive dentistry, St. Joseph Dental College and Hospital, Eluru, Andhra Pradesh, India. Operator not mentioned

Participants

60 children, 60 teeth, age range 5 to 9 years

Interventions

Group 1: Pulpotomy (Biodentine); n = 20 (1 visit)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation not mentioned

  • For haemostasis, moist cotton pellet

  • Irrigation not mentioned

  • Biodentine placed in the pulp chamber and condensed, followed by stainless‐steel crown

Group 2: Pulpotomy (diode laser); n = 20 (1 visit)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation not mentioned

  • Irrigation not mentioned

  • For haemostasis: Diode laser (Picasso) of 810 nm with the pulsed contact mode of application for 2 seconds delivered by optical fibre tip and 1.5 watt power, followed by ZOE then stainless‐steel crown

Group 3: Pulpotomy (MTA); n = 20 (1 visit)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation not mentioned

  • For haemostasis, moist cotton pellet

  • Irrigation not mentioned

  • MTA placed in the pulp chamber and condensed lightly with a moistened cotton pellet, followed by ZOE then stainless‐steel crown

Outcomes

Clinical criteria (pain, sinus tract, swelling and mobility), radiographic criteria (premature exfoliation, PDL widening, internal/external resorption and periapical/furcal radiolucency): evaluation at 3 and 6 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Noorollahian 2008

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Paediatric Dentistry Department, Faculty of Dentistry, Zahedan University of Medical Sciences, Iran. Operators not mentioned

Participants

46 children, 60 teeth, mean age 6.1 years, age range 5 to 7 years

Interventions

Group 1: Pulpotomy (formocresol); n = 30 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • For haemostasis, no precision

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE before being restored with stainless‐steel crown

Group 2: Pulpotomy (MTA); n = 30 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • For haemostasis, no precision

  • No irrigation

  • MTA (3:1 powder:water ratio) applied after pulpotomy. A cotton pellet moistened with normal saline was placed over the MTA paste and the tooth was temporarily restored using ZOE. Then ZOE before being restored with stainless‐steel crown after 24 hours

Outcomes

Clinical success (no pain symptoms, no tenderness of percussion, no swelling, no fistulation or no pathological mobility), radiological success (no evidence of radicular radiolucency, no internal or external root resorption or no periodontal ligament space widening), signs of failure (internal root resorption, furcation radiolucency, periapical bone destruction, pain, swelling or sinus tract), furcation involvement, pulp canal obliteration: evaluation at 6, 12 and 24 months (at tooth level)

Notes

Dropouts: at 24 months "12 out of 30 teeth in the two groups", no reasons stated

Source of funding: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random number table

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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: "...the children were examined clinically by the author who was blind to which treatment group the subject belonged"

Blinding of radiological outcomes assessment

Low risk

Quote: "...the children were examined radiographically by the author who was blind to which treatment group the subject belonged"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Olatosi 2015

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Pediatric Dentistry unit of the Department of Child Dental Health Lagos University Teaching Hospital. Operator was a paediatric dentist

Participants

37 children, 50 teeth, mean age 6.1 years, age range 4 to 7 years

Interventions

Group 1: Pulpotomy (formocresol); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with slow bur

  • For haemostasis, moist cotton pellet

  • Irrigation not mentioned

  • Cotton wool pellet soaked with 1:5 diluted FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE before being restored with stainless‐steel crown

Group 2: Pulpotomy (MTA); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with slow bur

  • For haemostasis, moist cotton pellet

  • Irrigation not mentioned

  • MTA (3:1 powder:water ratio) applied after pulpotomy followed by ZOE before being restored with stainless‐steel crown

Outcomes

Clinical success (no pain, no tenderness to percussion, no swelling or sinus tract, no pathologic tooth mobility), radiological success (normal periodontal ligament space, no furcation or periapical radiolucency, no active/progressing internal root resorption, no pathologic external root resorption): evaluation at 1, 3, 6, 9, and 12 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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 assessment of the treated teeth which were only identified by code was carried out by two experienced dentists who were blinded to the treatment groups."

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Oliveira 2013a

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Paediatric Dentistry Department, University of São Paulo, Brazil. Operators not mentioned

Participants

45 children, 45 teeth, mean age not mentioned, age range 5 to 9 years

Interventions

Group 1: Pulpotomy (CH); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access with round bur

  • Pulp access with high‐speed and round carbide burs

  • Pulpotomy amputation with excavator

  • For haemostasis, no precision

  • Irrigation with saline

  • CH placed with no precision

Group 2: Pulpotomy (MTA); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access with round bur

  • Pulp access with high‐speed and round carbide burs

  • Pulpotomy amputation with excavator

  • For haemostasis, no precision

  • Irrigation with saline

  • MTA (0.16 g powder mixed with sterile saline to obtain a homogeneous paste)

Group 3: Pulpotomy (PC); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access with round bur

  • Pulp access with high‐speed and round carbide burs

  • Pulpotomy amputation with excavator

  • For haemostasis, no precision

  • Irrigation with saline

  • PC (0.16 g powder mixed with sterile saline to obtain a homogeneous paste)

Outcomes

Clinical success (no spontaneous pain, no swelling, no fistula or no mobility), radiological success (no evidence of furcation radiolucency, no internal root resorption, dentine bridge formation), intra‐canal obliteration, inter‐radicular bone destruction, intra‐canal obliteration: evaluation at 6, 12 and 24 months (at tooth level)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computerised random‐number generator

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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: "...each check‐up involved a clinical... examination of the pulpotomized teeth, which was performed by two blinded and previously calibrated investigators"

Blinding of radiological outcomes assessment

Low risk

Quote: "...each check‐up involved a... periapical radiographic examination of the pulpotomized teeth, which was performed by two blinded and previously calibrated investigators"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Ozalp 2005

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Pediatric Dentistry, University of Ankara, Turkey. Operators were 2 experienced paediatric dentists

Participants

76 children, 80 teeth, age range 4 to 9 years

Interventions

Group 1: Pulpectomy (ZOE); n = 20 (1 or 2 visits)

  • Rubber dam or cotton rolls

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • No pulpotomy amputation

  • No haemostasis

  • Instrumentation with barbed broaches

  • Irrigation with 5% sodium hypochlorite then 0.5% metronidazole solution

  • ZOE applied after pulpectomy. After the obturation of the canals, the pulp chambers were cleaned with moistened cotton pellets, before being restored with amalgam. 2 visits only in uncooperative children

Group 2: Pulpectomy (calcium hydroxide eugenol free); n = 20 (1 or 2 visits)

  • Rubber dam or cotton rolls

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • No pulpotomy amputation

  • No haemostasis

  • Instrumentation with barbed broaches

  • Irrigation with 5% sodium hypochlorite then 0.5% metronidazole solution

  • Sealapex (eugenol‐free CH) applied after pulpectomy. After the obturation of the canals, the pulp chambers were cleaned with moistened cotton pellets, before being restored with amalgam. 2 visits only in uncooperative children

Group 3: Pulpectomy (calcium hydroxide); n = 20 (1 or 2 visits)

  • Rubber dam or cotton rolls

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • No pulpotomy amputation

  • No haemostasis

  • Irrigation with 5% sodium hypochlorite then 0.5% metronidazole solution

  • Instrumentation with barbed broaches

  • Calcicur applied after pulpectomy. After the obturation of the canals, the pulp chambers were cleaned with moistened cotton pellets, before being restored with amalgam. 2 visits only in uncooperative children

Group 4: Pulpectomy (calcium hydroxide + iodoform); n = 20 (1 or 2 visits)

  • Rubber dam or cotton rolls

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • No pulpotomy amputation

  • No haemostasis

  • Irrigation with 5% sodium hypochlorite then 0.5% metronidazole solution

  • Instrumentation with barbed broaches

  • Vitapex (CH/iodoform) applied after pulpectomy. After the obturation of the canals, the pulp chambers were cleaned with moistened cotton pellets, before being restored with amalgam. 2 visits only in uncooperative children

Outcomes

Clinical success (no pain, no gingival swelling, no tenderness to percussion, no abnormal mobility, no fistula or no abscess), radiological success (no (increase in size of) furcation radiolucency, no (increase in size of) periapical radiolucency, no (increase in size of) discontinuity of lamina dura and no (increase in size of) pathological root resorption), tenderness to percussion, pathological mobility, periapical radiolucency, pathological root resorption, excess filling material and its resorption: evaluation at 2, 4, 6, 8, 10, 12 and 18 months (at tooth level)

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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: "The clinical success were assessed by the clinicians blindly"

Blinding of radiological outcomes assessment

Low risk

Quote: "The radiographic success were assessed by the clinicians blindly"

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

Ozmen 2017

Methods

RCT, parallel arm

Teeth randomly assigned

Conducted at the Department of Pediatric Dentistry, Turkey. Operator was an investigator

Participants

26 children, 45 teeth, age range 6 to 9 years, mean age: 7.36 ± 0.96 years

Interventions

Group 1: Pulpotomy (FC); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with a high speed bur

  • Pulpotomy amputation with slow speed bur and excavator

  • For haemostasis, moist cotton pellets

  • Irrigation with saline

  • A cotton pellet moistened with 1:5 strength FC was placed on the pulp stumps for 5 min, followed by ZOE before being restored with amalgam or stainless steel crown

Group 2: Pulpotomy (FS); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with a high speed bur

  • Pulpotomy amputation with slow speed bur and excavator

  • For haemostasis, moist cotton pellets

  • Irrigation with saline

  • A cotton pellet moistened with 15.5% FS solution was placed on pulp stumps for 15 sec. Pulp chamber was dried with sterile cotton pellets, followed by ZOE before being restored with amalgam or stainless steel crown

Group 3: Pulpotomy (Ankaferd Blood Stopper); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with a high speed bur

  • Pulpotomy amputation with slow speed bur and excavator

  • For haemostasis, moist cotton pellets

  • Irrigation with saline

  • A cotton pellet moistened with ABS solution was placed on the pulp stumps for 15 sec. Pulp chamber was dried with sterile cotton pellets, followed by ZOE before being restored with amalgam or stainless steel crown

Outcomes

Clinical failure (spontaneous or severe pain, pathological mobility, swelling or sinus tract, tenderness to percussion or palpation), radiological failure (furcal or periapical radiolucency, didened periodontal ligament spaces, internal or external root resorption, loss of lamina dura), pulp canal obliteration: evaluation every 3 or 6 months (up to 24 months).

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Coin tossing

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Pinky 2011

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Outpatient Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, India. Operators not mentioned

Participants

28 children, 40 teeth, age range 4 to 10 years

Interventions

Group 1: Pulpectomy (ciprofloxacin + metronidazole + minocycline); n = 20 (3 visits)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • Haemostasis not mentioned

  • Irrigation with saline

3Mix (ciprofloxacin + metronidazole + minocycline) after pulpectomy. Commercially available chemotherapeutic agents such as ciprofloxacin, metronidazole and minocycline, were used. After removal of enteric coating, these drugs were pulverised using sterile porcelain mortar and pestle. These powdered drugs were mixed into 2 different combinations in the ratio of 1:3:3, i.e. 1 group being 1 part of ciprofloxacin, 3 parts of metronidazole and 3 parts of minocycline, kept separately to prevent exposure to light and moisture. 1 increment of each powdered drug was mixed with propylene glycol to form an ointment just before use. Canal orifices were enlarged to receive medicament termed as "medication cavity". This was accomplished using a round bur, following which cavities were cleaned and irrigated with the help of saline and dried. The medication cavities were filled with 1 of the pastes and given a temporary dressing with ZOE. Children were recalled after 15 days for resolution of clinical signs and symptoms, following which permanent restoration was done with glass‐ionomer cement. At 30 days, following successful treatment, stainless‐steel crowns were placed and x‐rays taken

Group 2: Pulpectomy (ciprofloxacin + ornidazole + minocycline); n = 20 (3 visits)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • Haemostasis not mentioned

  • Irrigation with saline

Ciprofloxacin + ornidazole + minocycline after pulpectomy. Commercially available chemotherapeutic agents such as ciprofloxacin, minocycline and ornidazole were used. After removal of enteric coating, these drugs were pulverised using sterile porcelain mortar and pestle. These powdered drugs were mixed into 2 different combinations in the ratio of 1:3:3, i.e. 1 group being 1 part of ciprofloxacin with 3 parts of ornidazole and 3 parts of minocycline, kept separately to prevent exposure to light and moisture. 1 increment of each powdered drug was mixed with propylene glycol to form an ointment just before use. Canal orifices were enlarged to receive medicament termed as "medication cavity". This was accomplished using a round bur, following which cavities were cleaned and irrigated with the help of saline and dried. The medication cavities were filled with 1 of the pastes and given a temporary dressing with ZOE. Children were recalled after 15 days for resolution of clinical signs and symptoms, following which permanent restoration was done with glass‐ionomer cement. At 30 days, following successful treatment, stainless‐steel crowns were placed and x‐rays taken

Outcomes

Clinical success (absence of spontaneous pain, tenderness to percussion, abnormal mobility and signs of pathology such as intraoral or extraoral abscess), pain symptoms, tenderness to percussion, abscess: evaluation at 3, 6 and 12 months (at tooth level)

Radiological success (radiolucency decreased compared with preoperative status or remained same), furcal radiolucency: evaluation at 6 and 12 months (at tooth level)

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

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

Prabhakar 2008

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the clinic of the department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, India. Operators not mentioned

Participants

41 children, 60 teeth, age range 4 to 10 years

Interventions

Group 1: Pulpotomy (3Mix); n = 30 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • For haemostasis, dry cotton pellet

  • Irrigation with saline

  • 3Mix (ciprofloxacin + metronidazole + minocycline) (with coronal pulp removed)

Only the necrotic coronal pulp was removed for pulpotomy. The orifice of the canal was enlarged and was termed as "medication cavity" which was half‐filled with antibacterial mix, before being restored with glass‐ionomer cement and composite

Group 2: Pulpectomy (3MIx); n = 30 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • For haemostasis, dry cotton pellet

  • No irrigation

  • 3Mix (ciprofloxacin + metronidazole + minocycline) (with coronal and radicular pulp tissue removed)

Both necrotic coronal as well as all accessible radicular pulp tissue was extirpated for pulpotomy. The orifice of the canal was enlarged and was termed as "medication cavity" which was half‐filled with antibacterial mix, before being restored with glass‐ionomer cement and composite

Outcomes

Pain symptoms, tenderness to percussion, pathological mobility, abscess: evaluation at 1, 6 and 12 months (at tooth level)

Furcal radiolucency: evaluation at 6 and 12 months (at tooth level)

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

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

Pramila 2016

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in Saveetha Dental College and Hospital, India. Operator was an investigator

Participants

88 children, 129 teeth, age range 4 to 9 years

Interventions

Group 1: Pulpectomy (RC Fill); n = 43 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access with high speed

  • Pulpotomy amputation with excavator

  • Instrumentation with barbed broaches and H‐files

  • Irrigation with saline and finally with 2% chlorhexidine

RC Fill available in powder and liquid form, mixed to the desired consistency according to the manufacturer’s instructions. A Lentulo spiral was used to place the RC Fill, followed by glass ionomer cement, before being restored with stainless steel crown.

Group 2: Pulpectomy (Vitapex); n = 43 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access with high speed

  • Pulpotomy amputation with excavator

  • Instrumentation with barbed broaches and H‐files

  • Irrigation with saline and finally with 2% chlorhexidine

Vitapex available in preformed syringes. The syringe was inserted into the canal near the apex. The paste was extruded into the canal, and the syringe was then slowly withdrawn as it filled the entire canal, followed by glass ionomer cement, before being restored with stainless steel crown.

Group 3: Pulpectomy (ZOE); n = 43 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access with high speed

  • Pulpotomy amputation with excavator

  • Instrumentation with barbed broaches and H‐files

  • Irrigation with saline and finally with 2% chlorhexidine

ZOE available in powder and liquid form, mixed to the desired consistency according to the manufacturer’s instructions. An Endodontic Pressure Syringe was used to place ZOE, followed by glass ionomer cement, before being restored with stainless steel crown.

Outcomes

Clinical failure (pain, tenderness to percussion, swelling/abscess, mobility and draining fistula), radiographic failure (furcation, radiolucency, periapical radiolucency, internal root resorption, external root resorption, lamina dura, deviation in the path of eruption, intraradicular resorption, resorption of extruded material), overall success: evaluation at 6, 12 and 30 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Low risk

Sequentially numbered, opaque and sealed envelopes

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "The participants and outcome assessors were blinded about the filling materials used"

Blinding of clinical outcomes assessment

Low risk

Quote: "The participants and outcome assessors were blinded about the filling materials used"

Blinding of radiological outcomes assessment

Low risk

Quote: "The participants and outcome assessors were blinded about the filling materials used"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% of children randomly assigned

Selective reporting (reporting bias)

Low risk

Protocol prospectively registered (CTRI/2011/06/001776). no discrepancies in outcomes between registered record and published RCT.

Rajasekharan 2017

Methods

RCT, parallel arm

Teeth randomly assigned

Conducted in the Department of Paediatric Dentistry and Special Care, University Hospital, Ghent University, Belgium. Operators were five (professor, doctoral graduate, doctoral student, master graduate and master student)

Participants

58 children, 81 teeth, age range 3 to 8 years, mean age: 4.79 ± 1.23

Interventions

Group 1: Pulpotomy (Biodentine); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with a high speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, cotton pellets

  • Irrigation not mentioned

  • Biodentine followed by glass ionomer cement before being restored with stainless steel crown

Group 2: Pulpotomy (MTA); n = 29 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with a high speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, cotton pellets

  • Irrigation not mentioned

  • White MTA followed by glass ionomer cement before being restored with stainless steel crown

Group 3: Pulpotomy (Tempophore); n = 27 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with a high speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, cotton pellets

  • Irrigation not mentioned

  • iodoform‐based paste followed by glass ionomer cement before being restored with stainless steel crown

Outcomes

Clinical and radiographic scoring criteria adapted from Zurn & Seale (2008): evaluation at 1, 6, 12 and 18 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computerised random number

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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: "All teeth were followed up clinically and radiographically by two blinded calibrated investigators"

Blinding of radiological outcomes assessment

Low risk

Quote: "All teeth were followed up clinically and radiographically by two blinded calibrated investigators"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Missing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups in two trials

Selective reporting (reporting bias)

High risk

Protocol retrospectively registered (NCT01733420). Registered primary outcomes were reported as secondary outcomes in the published article and new primary outcomes were introduced in the published article.

Ramar 2010

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai, India. Operators not mentioned

Participants

77 children, 96 teeth, age range 4 to 7 years

Interventions

Group 1: Pulpectomy (ZOE); n = 34 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • Pulpotomy amputation with excavator

  • Haemostasis not mentioned

  • Irrigation with a mixture of 2.25% sodium hypochlorite solution (1.5 mL) and 0.12% chlorhexidine gluconate (1.5 mL) used as the irrigant

  • Instrumentation with barbed broaches

  • The canal was dried using appropriate sized paper points, the size of the last used H‐file

  • ZOE with iodoform (RC FILL) applied after pulpectomy, followed by ZOE before being restored with stainless‐steel crown

Group 2: Pulpectomy (calcium hydroxide + iodoform); n = 30 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • Pulpotomy amputation with excavator

  • Haemostasis not mentioned

  • Irrigation with a mixture of 2.25% sodium hypochlorite solution (1.5 mL) and 0.12% chlorhexidine gluconate (1.5 mL) used as the irrigant

  • Instrumentation with barbed broaches

  • The canal was dried using appropriate sized paper points, the size of the last used H‐file.

  • Metapex (CH/iodoform) applied after pulpectomy, followed by ZOE before being restored with stainless‐steel crown

Group 3: Pulpectomy (ZOE + calcium hydroxide); n = 32 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with slow‐speed bur

  • Pulpotomy amputation with excavator

  • Haemostasis not mentioned

  • Irrigation with a mixture of 2.25% sodium hypochlorite solution (1.5 mL) and 0.12% chlorhexidine gluconate (1.5 mL) used as the irrigant

  • Instrumentation with barbed broaches

  • The canal was dried using appropriate sized paper points, the size of the last used H‐file

  • ZOE and CH with iodoform applied after pulpectomy, followed by ZOE before being restored with stainless‐steel crown

Outcomes

Pain symptoms, furcal radiolucency, periapical radiolucency, excess filling material and its resorption, faster root resorption compared with contralateral, slower root resorption compared with contralateral, similar root resorption compared with contralateral: evaluation at 3, 6 and 9 months (at tooth level)

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Rewal 2014

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Pedodontics and Preventive Dentistry, India. Operator was an investigator.

Participants

50 children, 50 teeth, age range 4 to 9 years

Interventions

Group 1: Pulpectomy (ZOE); n = 24 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with no precision

  • Pulpotomy amputation with excavator

  • Instrumentation with H‐files

  • Irrigation with 2.5% sodium hypochlorite alternatively with saline

  • Instrumentation with barbed broaches

  • A Lentulo spiral mounted on a slow speed hand piece was employed to introduce ZOE, followed by ZOE the stainless steel crown

Group 2: Pulpectomy (Endoflas); n = 26 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with no precision

  • Pulpotomy amputation with excavator

  • Instrumentation with H‐files

  • Irrigation with 2.5% sodium hypochlorite alternatively with saline

  • Instrumentation with barbed broaches

  • A Lentulo spiral mounted on a slow‐speed handpiece was employed to introduce Enfodlas, followed by ZOE the stainless steel crown

Outcomes

Clinical success (absence of pain, redness, swelling, tenderness on percussion, and sinus or fistula), radiographic success (reduction in the size of interradicular radiolucency or the size remaining the same): evaluation at 3, 6 and 9 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

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

Sabbarini 2008

Methods

RCT, split‐mouth

Teeth randomly assigned

Conducted in the paediatric dental clinics, Department of Pediatric Dentistry, Alexandria University, Egypt. Operators not mentioned

Participants

15 children, 30 teeth, mean age 5 years, standard deviation age 0.7 years, age range 4 to 7 years

Interventions

Group 1: Pulpotomy (formocresol); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by cavity base before being restored with glass‐ionomer cement and stainless‐steel crown

Group 2: Pulpotomy (EMD); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet

  • No irrigation

A cotton pellet was placed to cover the amputated pulpal stumps, and the tooth was then conditioned with polyacrylic acid gel. The cotton pellet was then removed, and the amputated pulpal stumps were covered with protein EMD gel from a 0.3 mL syringe, before being restored with glass‐ionomer cement and stainless‐steel crown

Outcomes

Clinical success (absence of pain, pain on percussion, mobility, and abscess or fistula formation), radiological success (normal periodontal ligament space and had an absence of furcation and periapical radiolucency, pulp calcification, and internal resorption), pain symptoms, tenderness to percussion, pathological mobility, sinus tract, abscess: evaluation at 2, 4 and 6 months (at tooth level)

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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: "2 examiners who were blinded to treatment type evaluated the teeth clinically"

Blinding of radiological outcomes assessment

Low risk

Quote: "2 examiners who were blinded to treatment type evaluated the teeth radiographically"

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

Sakai 2009

Methods

RCT, parallel‐arm

Teeth randomly assigned. Conducted in Brazil. Operators and setting not mentioned

Participants

30 children, 30 teeth, mean age 6.8 years, age range 5 to 9 years

Interventions

Group 1: Pulpotomy (Portland cement); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • For haemostasis, saline solution

  • Irrigation with saline

  • PC applied after pulpotomy, followed by IRM before being restored with glass‐ionomer cement

Group 2: Pulpotomy (MTA); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • For haemostasis, saline solution

  • Irrigation with saline

  • Grey MTA applied after pulpotomy, followed by IRM before being restored with glass‐ionomer cement

Outcomes

Clinical success (no spontaneous pain, no mobility, no swelling, no fistula or no smell), radiographic success (no internal root resorption and no furcation radiolucency, dentine bridge formation), swelling, pathological mobility, sinus tract, inflammation in the adjacent tissues, furcal radiolucency, internal resorption, pulp canal obliteration, dentine bridge formation: evaluation at 6, 12, 18 and 24 months (at tooth level)

Notes

Reasons of dropouts:

Group 1: 3 (of 24‐month follow‐up) + 3 (after 24 months) exfoliations

Group 2: 1 (of 18‐month follow‐up) + 1 (of  24‐month follow‐up) + 3 (after 24 months) exfoliations

Source of funding: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "The primary mandibular molars were randomly assigned to MTA or PC groups by the toss of a coin"

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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 examination… which was performed by two blinded and previously calibrated investigators"

Blinding of radiological outcomes assessment

Low risk

Quote: "Periapical radiographic examination… which was performed by two blinded and previously calibrated investigators"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Saltzman 2005

Methods

RCT, split‐mouth

Teeth randomly assigned

Conducted in the University of Toronto Faculty of Dentistry Paediatric Clinic, Canada. Operators were 1 of 7 paediatric dental residents, including the primary investigator

Participants

16 children, 52 teeth, mean age 5.1 years, age range 3 to 8 years

Interventions

Group 1: Pulpotomy (formocresol); n = 26 (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, no precision

  • Irrigation with saline

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE before being restored with stainless‐steel crown

Group 2: Pulpotomy (MTA); n = 26 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation: 980 nm diode laser set at 3 W of power with a continuous pulse. Multiple applications

  • For haemostasis, no precision

  • No irrigation

  • MTA applied after pulpotomy, before being restored with glass‐ionomer cement (which was placed over the MTA to achieve a firm foundation and prevent disturbance of the unset MTA material) and stainless‐steel crown

Outcomes

Clinical success (teeth remained asymptomatic, absence of a sinus tract, premature tooth loss), radiographic success (absence of furcal radiolucencies, pathological root resorption, damage to succedaneous follicle, or a combination), signs of success (teeth remained asymptomatic, absence of a sinus tract, absence of furcal radiolucencies, pathological root resorption, damage to succedaneous follicle and premature tooth loss, or a combination), furcal radiolucency, periapical radiolucency, pathological root resorption, root resorption in relation to contralateral: evaluation at (mean ± standard deviation) 2.3 ± 2.1, 5.2 ± 1.9, 9.5 ± 2.3 and 15.7 ±3 months (at tooth level)

Notes

4 follow‐up visits (mean ± standard deviation): first: 2.3 ± 2.1, second: 5.2 ± 1.9, third: 9.5 ± 2.3, fourth: 15.7 ± 3.0 months

Source of funding: quote: "The investigators wish to thank BioLitec and Lasers in Dentistry for the donation of the diode laser, and Dentsply for the donation of the MTA. Funding for this study was provided by the University of Toronto and Alpha Omega. The authors of this study do not have any financial interest in the commercial products used"

Comment: Alpha Omega International Dental Fraternity is a Jewish philanthropic charity and presents no apparent conflict of interests

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Coin toss

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

High risk

Quote: "clinical outcome assessments were made by the primary investigator at each follow‐up visit"

Blinding of radiological outcomes assessment

Low risk

Quote: "radiographic outcome assessments were made by the primary investigator and one independent experienced clinician who was blind to the treatment"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Shabzendedar 2013

Methods

RCT, parallel arm

Teeth randomly assigned

Conducted in the clinic of the Pediatric Dentistry Department of the university's School of Dentistry. Operators not mentioned

Participants

100 children, 100 teeth, mean age 4.3 years, age range 3 to 6 years

Interventions

Group 1: Pulpotomy (formocresol); n = 50 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with low‐speed bur

  • Pulpotomy amputation with no 6 carbide round bur

  • For haemostasis, water‐moistened cotton pellet

  • Irrigation with saline

  • cotton pellet moistened with FC (for one minute), followed by IRM before being restored with stainless‐steel crown

Group 2: Pulpotomy (3% NaOCl); n = 50 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with low‐speed bur

  • Pulpotomy amputation with no 6 carbide round bur

  • For haemostasis, water‐moistened cotton pellet

  • Irrigation with saline

  • cotton pellet saturated with three percent NaOCI (for 30 seconds), followed by IRM before being restored with stainless‐steel crown

Outcomes

Clinical success (no pain symptoms, tenderness to percussion, swelling, fistula, and pathologic mobility), radiographic success (no evidence of inter‐radicular radiolucency, internal or external root resorption, and periapical radiolucency): evaluation at 6 and 12 months

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computerised random number generator

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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: "The dentists assessing the outcomes were blinded to group assignment"

Blinding of radiological outcomes assessment

Low risk

Quote: "The dentists assessing the outcomes were blinded to group assignment"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Shumayrikh 1999

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the paediatric dentistry postgraduate clinics of King Saud University College of Dentistry, Saudi Arabia. Operators not mentioned

Participants

19 children, 61 teeth, age range 5 to 10 years

Interventions

Group 1: Pulpotomy (glutaraldehyde + ZOE); n = 30 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation not mentioned

  • For haemostasis, the pulp chamber was cleaned with 3% hydrogen peroxide on a cotton pellet to remove any remaining blood clot

  • This was followed by further irrigation with 0.9% saline solution and drying with sterile cotton pellets

  • 2% glutaraldehyde placed on pulp stumps for 3 minutes after pulpotomy, followed by eugenol + IRM and compomer before being restored with stainless‐steel crown 1 or 2 weeks after

Group 2: Pulpotomy (glutaraldehyde + calcium hydroxide); n = 31 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation not mentioned

  • For haemostasis, the pulp chamber was cleaned with 3% hydrogen peroxide on a cotton pellet to remove any remaining blood clot

  • This was followed by further irrigation with 0.9% saline solution and drying with sterile cotton pellets

  • 2% glutaraldehyde placed on pulp stumps for 3 minutes after pulpotomy, followed by CH and compomer before being restored with stainless‐steel crown 1 or 2 weeks after

Outcomes

Clinical success (no history of pain, no swelling or sinus tract, no history of thermal sensitivity and no tenderness to percussion), radiographic success (no loss of lamina dura, no loss of trabecular bone, no furcal or periapical radiolucency and no internal resorption), pain symptoms, thermal sensitivity, tenderness to percussion, internal root resorption, changes in the integrity of lamina dura, loss of trabecular bone, furcal or periapical radiolucency: evaluation at 12 months (at tooth level)

Notes

Reasons of dropouts: 2 children with 4 treated teeth did not attend the follow‐up appointments

Source of funding: quote: "This project was supported by a grant from the College of Dentistry Research Center (CDRC) at King Saud University"

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "...the teeth treated by pulpotomy were only identified by code under the supervision of the assistant"

Blinding of clinical outcomes assessment

Low risk

Quote: "...clinical evaluations of the treated teeth were carried out by the investigator without knowing which tooth had been treated with"

Blinding of radiological outcomes assessment

Low risk

Quote: "...radiographic evaluations of the treated teeth were carried out by the investigator without knowing which tooth had been treated with…" "the… radiographs… were also evaluated by the principal investigator and another pediatric dentist"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Sonmez 2008

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Clinic of the Pediatric Dentistry Department at the Ankara University, Turkey. Operator was the same paedodontist

Participants

Treated: 16 children, 80 teeth; analysed: 11 children, 56 teeth, mean age 6.6 years, age range 4 to9 years

Interventions

Group 1: Pulpotomy (formocresol); n = 13 (analysed) (1 visit)

  • Cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • For haemostasis, moistened cotton pellet with saline

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE and zinc phosphate cement before being restored with amalgam

Group 2: Pulpotomy (ferric sulphate); n = 15 (analysed, not treated) (1 visit)

  • Cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • For haemostasis, moistened cotton pellet with saline

  • No irrigation

  • After coronal pulp amputation, the pulp stump were flushed with water by using an air‐water syringe, and the pulp chamber was dried with sterile cotton pellets

  • FS (15.5%) applied to pulp stumps for 10‐15 seconds after pulpotomy, followed by ZOE and zinc phosphate cement before being restored with amalgam

Group 3: Pulpotomy (calcium hydroxide); n = 13 (analysed, not treated) (1 visit)

  • Cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • For haemostasis, moistened cotton pellet with saline

  • No irrigation

  • CH was applied to pulp stumps after pulpotomy, before being restored with glass‐ionomer cement and amalgam

Group 4: Pulpotomy (MTA); n = 15 (analysed, not treated) (2 visits)

  • Cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation not mentioned

  • For haemostasis, moistened cotton pellet with saline

  • No irrigation

  • MTA applied after pulpotomy (3:1 powder:distilled water ratio), followed by ZOE, before being restored with amalgam 24 hours postoperatively

Outcomes

Clinical success (no symptoms of pain, no tenderness on percussion, no swelling, no fistulae or no pathological mobility), radiographic success (no periradicular or inter‐radicular radiolucency, no external or internal resorption or no periodontal ligament space widening), signs of success (no symptoms of pain, no tenderness of percussion, no swelling, no fistulae or no pathological mobility, no periradicular or inter‐radicular radiolucency, no external or internal resorption or no periodontal ligament space widening), internal resorption, external resorption, pulp canal obliteration: evaluation at 6, 12, 18 and 24 months (at tooth level)

Notes

5 excluded participants. Quote: "Four children did not come to follow‐up appointments 6 months after the first treatment and were excluded from the study. Follow‐up of one child with four pulpotomised primary molars had to be discontinued after 1 year because the family moved to another city."

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Subramaniam 2009

Methods

RCT, split‐mouth

Teeth randomly assigned

Conducted in the Department of Pedodontics and Preventive Dentistry, The Oxford Dental College, Hospital and Research Center, Bangalore, India. Operators not mentioned

Participants

19 children, 40 teeth, age range 6 to 8 years

Interventions

Group 1: Pulpotomy (formocresol); n = 20 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet with water

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 1 minute after pulpotomy, followed by ZOE before being restored with glass‐ionomer cement and stainless‐steel crown 1 week after

Group 2: Pulpotomy (MTA); n = 20 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet with water

  • No irrigation

  • MTA (3:1 powder:saline ratio) applied after pulpotomy, followed by ZOE before being restored with glass‐ionomer cement and stainless‐steel crown 1 week after

Outcomes

Clinical success (no history of pain, no tenderness to percussion, no gingival abscess, no sinus/fistula and no pathological mobility), radiographic success (no internal/external root resorption or no periapical/furcal radiolucency), signs of success (no history of pain, no tenderness to percussion, no gingival abscess, no sinus/fistula and no pathological mobility, no internal/external root resorption or no periapical/furcal radiolucency), furcal radiolucency, pulp canal obliteration, dentine bridge formation: evaluation at 1, 6, 12 and 24 months (at tooth level)

Notes

Source of funding: not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Coin toss

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

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

Subramaniam 2011

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Pedodontics and Preventive Dentistry, The Oxford Dental College, Hospital and Research Centre, Bangalore, India. Operators not mentioned

Participants

Number of enrolled children not mentioned, 45 teeth, age range 5 to 9 years

Interventions

Group 1: Pulpectomy (calcium hydroxide + iodoform); n = 15 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • No haemostasis

  • Irrigation with saline and 1% sodium hypochlorite

  • Instrumentation with smooth broaches or H files

  • Metapex (CH/iodoform) applied after pulpectomy, followed by ZOE and Miracle mix, before being restored with stainless‐steel crown 1 week later

Group 2: Pulpectomy (calcium hydroxide + ZOE + iodoform); n = 15 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • No haemostasis

  • Irrigation with saline and 1% sodium hypochlorite

  • Instrumentation with smooth broaches or H files

  • Endoflas (CH + ZOE + iodoform) applied after pulpectomy, followed by ZOE and Miracle mix, before being restored with stainless‐steel crown 1 week later

Group 3: Pulpectomy (ZOE); n = 15 (2 visits)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with excavator

  • No haemostasis

  • Irrigation with saline and 1% sodium hypochlorite

  • Instrumentation with smooth broaches or H files

  • ZOE applied after pulpectomy, followed by ZOE and Miracle mix, before being restored with stainless‐steel crown 1 week later

Outcomes

Clinical success (no gingival swelling/inflammation/redness, no sinus opening in the oral mucosa or purulent exudate expressed from the gingival margin, no abnormal mobility other than mobility due to normal exfoliation, absence of pain on percussion/tenderness), radiographic success (no evidence of extensive pathological root resorption, reduction or no change in preoperative pathological inter‐radicular or periapical radiolucency (or both), no evidence of development of new postoperative pathological radiolucency involving the succedaneous tooth germ), pain symptoms, tenderness to percussion, swelling, pathological mobility, pathological root resorption, damage in succedaneous follicle: evaluation at 3, 6, 12 and 18 months (at tooth level)

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

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

Trairatvorakul 2008

Methods

RCT, parallel‐arm

Teeth randomly assigned. Conducted in Thailand

Setting not mentioned. Operator was 1 investigator (paediatric dentist)

Participants

42 children, 54 teeth, mean age 5.6 years, standard deviation age 1.2 years, age range 3.3 to 7.8 years

Interventions

Group 1: Pulpectomy (ZOE); n = 27 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • No pulpotomy amputation

  • No haemostasis

  • Irrigation with 2.5% sodium hypochlorite

  • Instrumentation with barbed broaches

  • ZOE after pulpectomy before being restored with stainless‐steel crown

Group 2: Pulpectomy (calcium hydroxide + iodoform); n = 27 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • No pulpotomy amputation

  • No haemostasis

  • Irrigation with 2.5% sodium hypochlorite

  • Vitapex (CH/iodoform) paste after pulpectomy before being restored with stainless‐steel crown

Outcomes

Clinical success (no pain, healthy soft tissue (defined as the absence of swelling, redness or sinus tract) and no abnormal mobility), radiographic success (radiographic continuity of the lamina dura, reduction in the size of any pathological inter‐radicular or periapical radiolucencies (or both) or evidence of bone regeneration), signs of success (absence of change or more discontinuity of lamina dura and absence of change in size of radiolucency area), pain symptoms, swelling, fistula, pathological mobility: evaluation at 6 and 12 months (at tooth level)

Notes

Source of funding: "The authors wish to thank the Chulalongkorn University Postgraduate Research Fund for financial support"

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Block randomisation

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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: "the clinical diagnoses were blindly assessed by another investigator"

Blinding of radiological outcomes assessment

Low risk

Quote: "the radiographic diagnoses were blindly assessed by another investigator"

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

Tuna 2008

Methods

RCT, split‐mouth

Teeth randomly assigned. Conducted in Turkey

Setting and operators not mentioned

Participants

25 children, 50 teeth, age range 5 to 8 years

Interventions

Group 1: Direct pulp capping (MTA + ZOE); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • No pulpotomy amputation

  • For haemostasis, moistened cotton pellet

  • Irrigation with saline

  • MTA (3:1 powder:saline ratio) applied as a direct pulp cap for an exposure < 1 mm pulpotomy, followed by ZOE before being restored with amalgam

Group 2 : Direct pulp capping (CH + ZOE); n = 25 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • No pulpotomy amputation

  • For haemostasis, moistened cotton pellet

  • Irrigation with saline

  • CH was applied as a direct pulp cap for an exposure < 1 mm pulpotomy, followed by ZOE before being restored with amalgam

Outcomes

Clinical success (no spontaneous pain, no tenderness of percussion, no swelling, no fistulation or no pathological mobility), radiographic success (no furcation radiolucency, no periodontal ligament space widening or no internal or external root resorption), thermal sensitivity: evaluation at 3, 6, 12, 18 and 24 months (at tooth level)

Notes

Reasons of dropouts: 1 child did not return for evaluation after 1 month, 1 after 9 months and 1 after 12 months because of the loss of restoration that had been placed on the pulp capping material, 1 tooth was excluded from the clinical study after 9 months and 1 tooth after 18 months, both from the CH group

Lost to follow‐up: Group 1: failure to attend, n = 3; Group 2: failure to attend, n = 3; loss of restoration, n = 2

Analysed: Group 1: n = 22; Group 2: n = 20. No exclusions

Source of funding: quote: "This study was supported financially by the Scientific Research Foundation of Gazi University, Ankara, Turkey (grant no. 03/2003‐15)"

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)

Unclear risk

Insufficient information to make a clear judgement

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: "...two investigators, who attended a calibration session before the follow‐up examinations, blindly evaluated the teeth clinically"

Blinding of radiological outcomes assessment

Low risk

Quote: "...two investigators, who attended a calibration session before the follow‐up examinations, blindly evaluated the teeth radiographically"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Uloopi 2016

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Paediatric Dentistry, Vishnu Dental College, Bhimavaram. Operator not mentioned

Participants

29 children, 40 teeth, mean 5.6, age range 4 to 7 years

Interventions

Group 1: Pulpotomy (MTA); n = 20 (1 visit)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access not mentioned

  • Pulp access with high speed hand piece

  • Pulpotomy amputation with excavator

  • For haemostasis, moist cotton pellet with saline

  • Irrigation with saline

  • MTA 3:1, condensed lightly with a moistened cotton pellet, followed by glass ionomer cement then stainless‐steel crown

Group 2: Pulpotomy (low‐level laser therapy);n = 20 (1 visit)

  • Rubber dam not mentioned

  • Caries removal prior to pulpal access not mentioned

  • Pulp access not mentioned

  • Pulpotomy amputation not mentioned

  • Irrigation not mentioned

  • For haemostasis, moist cotton pellet with saline

  • DenLaseTM Diode Laser of wavelength 810 nm, under continuous mode, energy 2 J/cm² applied over the radicular stumps for about 10 seconds, followed by glass ionomer cement then stainless‐steel crown

Outcomes

Clinical success (no pain, tenderness to percussion, swelling, fistulation or pathologic mobility), radiologic success (no radicular radiolucency, internal or external root resorption or periodontal ligament space widening), overall success: evaluation at 3, 6 and 12 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Ulusoy 2014a

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Department of Pedodontics, Faculty of Dentistry, Turkey. Operator was the principal investigator

Participants

40 children, 40 teeth, mean age 7.3 years, age range 5 to 9 years

Interventions

Group 1: Pulpotomy (CH cement/Dycal); n = 20 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed followed by slow‐speed and varbide burs

  • For haemostasis, moist cotton pellet

  • Solutions rinsed with saline

  • CH cement (Dycal) applied to the exposure site with bal‐ended instruments, followed by glass ionomer cement liner before being restored with amalgam

Group 2: Pulpotomy (calcium sulphate hemihydrate/Dentogen); n = 20 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed followed by slow‐speed and varbide burs

  • For haemostasis, moist cotton pellet

  • Solutions rinsed with saline

  • calcium sulphate hemihydrate (Dentogen) applied to the exposure site with ball‐ended instruments, followed by glass ionomer cement liner before being restored with amalgam

Outcomes

Clinical success (no pathologic mobility, fistula, spontaneous pain, sensitivity to percussion/palpation, oedema), radiographic success (no external root resorption, internal root resorption, inter‐radicular radiolucency, periapical radiolucency), inter‐radicular radiolucency, external root resorption, internal root resorption, fistula, pathologic mobility, spontaneous pain: evaluation at 1, 3, 6, 9 and 12 months (at tooth level).

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

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: "...all clinical... recall examinations were performed by the same clinician who was blinded to the treatment groups"

Blinding of radiological outcomes assessment

Low risk

Quote: "...all... radiographic recall examinations were performed by the same clinician who was blinded to the treatment groups"

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

Vargas 2006

Methods

RCT, split‐mouth

Teeth randomly assigned

Conducted in the Department of Pediatric Dentistry, The University of Iowa, Iowa City, Iowa, USA. Operator was the principal investigator

Participants

23 children, 60 teeth, mean age 5 years, age range 4 to 9 years

Interventions

Group 1: Pulpotomy (ferric sulphate); n = 28 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with slow‐speed bur

  • For haemostasis, dry cotton pellet

  • Solutions rinsed with water

  • FS applied after pulpotomy for 15 seconds, followed by IRM before being restored with stainless‐steel crown

Group 2: Pulpotomy (sodium hypochlorite); n = 32 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access not mentioned

  • Pulpotomy amputation with slow‐speed bur

  • For haemostasis, dry cotton pellet

  • Solutions rinsed with water

  • Cotton wool pellet soaked with 5% sodium hypochlorite placed on pulp stumps for 30 seconds after pulpotomy, followed by IRM before being restored with stainless‐steel crown

Outcomes

Clinical failure (mobility, swelling, fistula, history of spontaneous pain), radiographic success (no external root resorption, no internal root resorption, no inter‐radicular bone destruction), overall success ((% clinical success + % radiographic success)/2), pain palpation, swelling, fistula, pathological mobility, redness, bleeding, furcation involvement, internal resorption: evaluation at 6 and 12 months (at tooth level)

Notes

No reason of dropouts, except "2 teeth exfoliated and were eliminated from further follow‐up"

Source of funding: quote: "This research was supported by the Obermann Center for Advanced Studies Spelman Rockefeller Grant from The University of Iowa, Iowa City, Iowa"

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated random table

Allocation concealment (selection bias)

Low risk

Quote: "subject assignment was made at the consent appointment, but allocation of the tooth according to the allocation sequence was made the day of the treatment visit"; "this allocation followed the current guidelines for randomised clinical trials put forth by CONSORT [Consolidated Standards of Reporting Trials]"

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Quote: "...the clinical examination was performed by the principal investigator without immediate knowledge of which treatment has been rendered on which tooth"

Blinding of radiological outcomes assessment

Low risk

Quote: "...all radiographs were read… by 2 co‐investigators who were blinded to the technique used"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Waterhouse 2000

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the paediatric dental clinic within the Dental Hospital, Newcastle‐upon‐Tyne, UK. Operator not mentioned

Participants

52 children, 84 teeth, mean age 5 years, age range 3.3 to 12.5 years

Interventions

Group 1: Pulpotomy (formocresol); n = 46 (1 visit)

  • Rubber dam or cotton rolls

  • Caries removal prior to pulpal access not mentioned

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with slow‐speed bur and excavator

  • For haemostasis, cotton pellet

  • Irrigation with saline

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE before being restored with glass‐ionomer cement or composite or amalgam, and stainless‐steel crown if indicated

Group 2: Pulpotomy (calcium hydroxide); n = 38 (1 visit)

  • Rubber dam or cotton rolls

  • Caries removal prior to pulpal access not mentioned

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with slow‐speed bur and excavator

  • For haemostasis, cotton pellet

  • Irrigation with saline

  • CH applied after pulpotomy, followed by ZOE before being restored with glass‐ionomer cement or composite or amalgam, and stainless‐steel crown if indicated

Outcomes

Clinical failure (symptoms from the treated tooth reported by the child or parent, spontaneous pain, pain initiated by stimuli, signs of defective restoration or recurrent caries, signs of mobility, sinus formation, tenderness to percussion, soft tissues swelling, signs of exfoliation, mobility or signs/symptoms of the successor tooth erupting), tenderness to percussion, swelling, pathological mobility, sinus tract, secondary caries, defective restoration: evaluation at 6 and 12 months (at tooth level)

Radiographic success (defective restoration or recurrent caries, periradicular pathology such as periapical or furcal radiolucency, pathological internal resorption, replacement resorption, intracanal calcifications, physiological root resorption, position and eruption pathway of the permanent successor tooth), periradicular radiolucency, furcal radiolucency, periapical radiolucency, internal resorption, pulp canal obliteration, physiological root resorption, recurrent caries: evaluation at 12 months (at tooth level)

Notes

5 teeth lost to follow‐up

Clinical follow‐up: 22.5 months (range 6.1 to 38.5)

Radiographic follow‐up: 18.9 months (range 1.3 to 36.9)

Source of funding: "This study was supported by The Shirley Glasstone‐Hughes Memorial prize awarded to the authors by the British Dental Association, in September 1993"

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Coin toss

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

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: "Objectivity was maximized during clinical assessment, by not having direct access to records detailing which pulp therapy agent was used"

Blinding of radiological outcomes assessment

Low risk

Quote: "Objectivity was maximized during radiographic assessment, by not having direct access to records detailing which pulp therapy agent was used"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Yadav 2014

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in Sudha Rustagi Dental College, Faridabad. Operator not mentioned

Participants

37 children, 45 teeth, age range 4 to 7 years

Interventions

Group 1: Pulpotomy (15.5% ferric sulphate); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moist cotton pellet soaked in saline

  • Irrigation with saline

Cotton pellet was first saturated with 15.5% ferric sulphate and later compressed between gauze to remove excess so it was just moistened with the solution. It was then placed for 15 seconds on amputated pulp stumps. After this the pulp stumps were observed for brownish to black discolouration of the fixed radicular pulp tissue. Excess ferric sulphate was flushed from the pulp chamber with copious amount of saline and clot remnants were removed from the chamber followed by placement of a thick mix of zinc oxide eugenol into the pulp chamber. Then teeth restored by glass ionomer cement

Group 2: Pulpotomy (electrosurgery); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moist cotton pellet soaked in saline

  • Irrigation with saline

The ART‐E1 electrosurgery unit was set at COAG 1 mode to perform both electrofulguration and electrocoagulation. The handpiece with appropriate electrode tips, kept 1 to 2 mm away from the pulpal tissue, was used to deliver the electric current. The duration of application was not more than 2 to 3 seconds followed by a cool down period of 5 seconds. If necessary, this procedure was repeated up to a maximum of three times. After each current application, a new large moist sterile cotton pellet was placed with pressure on the pulpal tissue near to orifice to absorb any blood or tissue fluids before the next current application (e.g. pellet‐electrode‐pellet‐electrode). When properly completed, the pulpal stumps appeared dry and completely blackened. This was followed by placement of a thick mix of zinc oxide eugenol into the pulp chamber. Then teeth restored by glass ionomer cement

Group 3: Pulpotomy (diode laser); n = 15 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moist cotton pellet soaked in saline

  • Irrigation with saline

The remaining coronal pulp tissue was exposed to laser energy through an optical fibre using the diode laser (810 nm, output power: 7 W) set at 3 W of power in Continuous Wave. The laser energy was delivered through a 400 μm diameter optical fibre in a non contact mode with pulp tissue for not more than 2‐3 sec (PD = 2388.53, Fluence = 7165.60). Application of laser was administered until the pulp was ablated and complete haemostasis was achieved. All children and clinical staff wore appropriate eye protection during application of the laser. Applications were administered as per the requirement of each tooth followed by placement of a thick mix of zinc oxide eugenol into the pulp chamber. Then teeth restored by glass ionomer cement

Outcomes

Clinical success (absence of pain and tenderness, absence of abscess, absence of sinus or fistula, absence of mobility), radiographic success (absence of widened periodontal space, absence of inter‐radicular or periapical radiolucency, absence of sinus or fistula, absence of internal resorption, absence of abnormal canal calcification): evaluation at 1, 3, 6 and 9 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Yildirim 2016

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Gülhane Military Medical Academy (GMMA) Pediatric Dentistry Clinic. One operator (investigator).

Participants

65 children, 140 teeth, age range 5 to 9 years

Interventions

Group 1: Pulpotomy (formocresol); n = 35 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access (no detail)

  • Pulp access (no detail)

  • Pulpotomy amputation with excavator

  • For haemostasis, sterile cotton pellet soaked in sterile saline

  • Irrigation with water

  • Cotton wool pellet soaked with FC placed on pulp stumps for 3‐4 minutes after pulpotomy, followed by ZOE before being restored with glass‐ionomer cement and stainless‐steel crown

Group 2: Pulpotomy (MTA); n = 35 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access (no detail)

  • Pulp access (no detail)

  • Pulpotomy amputation with excavator

  • For haemostasis, sterile cotton pellet soaked in sterile saline

  • Irrigation with water

  • MTA 3:1, followed by glass‐ionomer cement and stainless‐steel crown

Group 3: Pulpotomy (Portland cement); n = 35 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access (no detail)

  • Pulp access (no detail)

  • Pulpotomy amputation with excavator

  • For haemostasis, sterile cotton pellet soaked in sterile saline

  • Irrigation with water

  • PC sterilised with ethylene oxide prior to use, 0.16 g of the cement mixed with distilled water until a homogeneous pat, followed by ZOE before being restored with glass‐ionomer cement and stainless‐steel crown

Group 4: Pulpotomy (EMD); n = 35 (1 visit)

  • Rubber dam

  • Caries removal prior to pulpal access (no detail)

  • Pulp access (no detail)

  • Pulpotomy amputation with excavator

  • For haemostasis, sterile cotton pellet soaked in sterile saline

  • Irrigation with water

  • 0.7 mL EMD injected to fill the pulp tissue, followed by ZOE before being restored with glass‐ionomer cement and stainless‐steel crown

Outcomes

Clinical failure (spontaneous pain, swelling, fistula), radiological failure (radiolucency of the periapical or furcation, and pathological external root resorption), overall success, pulp canal obliteration, internal root resorption, marginal adaptation of the crown, crushing or deformities of the crown, changes in occlusion: evaluation at 3, 6, 12, 18, and 24 months

Notes

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)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Proportion of missing outcomes < 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Zealand 2010

Methods

RCT, parallel‐arm

Teeth randomly assigned

Conducted in the Children's Clinic of the University of Michigan School of Dentistry, USA. Operator not mentioned

Participants

152 children, 252 teeth, mean age 5.5 years, standard deviation age 1.5 years, age range 2.5 to 10 years

Interventions

Group 1: Pulpotomy (formocresol); n = 133 (1 visit)

  • Rubber dam or cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with slow speed bur and excavator

  • For haemostasis, cotton pellet

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by IRM before being restored with stainless‐steel crown

Group 2: Pulpotomy (MTA); n = 119 (1 visit)

  • Rubber dam or cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with slow speed bur and excavator

  • For haemostasis, cotton pellet

  • No irrigation

  • Grey MTA (MTA 3:1 powder/saline ratio) applied after pulpotomy, followed by IRM before being restored with stainless‐steel crown

Outcomes

Clinical success (not clearly defined), radiographic failure (internal root resorption, external root resorption, internal root resorption with perforated form, periradicular lesion), score 2‐1 (clinically), score 2‐2 (clinically), score 2‐3 (clinically), score 2‐4 (clinically), internal resorption, internal resorption with perforated form, external resorption, periodontal ligament widening, pulp canal obliteration, dentine bridge formation, score 7‐1 (rx), score 7‐2 (rx), score 7‐3 (rx), score 7‐4 (rx): evaluation at 6 months (at tooth level)

Notes

203/252 teeth were available for the 6‐month evaluation resulting in 19% lost at follow‐up

Source of funding: "This study was supported by Michigan Institute for Clinical & Health Research and Delta Dental Foundation of Michigan. The authors declare no conflict of interest"

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

Quote: "Randomization of the medicament used was done by an envelope draw"

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: "The blinded clinical examination was performed by 1 to 19 operators who were calibrated to the clinical scoring criteria"

Blinding of radiological outcomes assessment

Low risk

Quote: "All radiographs were viewed by 4 blinded, calibrated evaluators"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

Zurn 2008

Methods

RCT, split‐mouth

Teeth randomly assigned

Conducted in the Department of Pediatric Dentistry, Baylor College of Dentistry Texas, Health Science Center, Dallas, Texas, USA. Operator were 2 standardised operators

Participants

23 children, 76 teeth, mean age 5.3 years, standard deviation age 1.7 years, age range 2.3 to 8.5 years

Interventions

Group 1: Pulpotomy (formocresol); n = 38 (1 visit)

  • Rubber dam or cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet with water

  • No irrigation

  • Cotton wool pellet soaked with FC placed on pulp stumps for 5 minutes after pulpotomy, followed by ZOE before being restored with stainless‐steel crown

Group 2: Pulpotomy (calcium hydroxide); n = 38 (1 visit)

  • Rubber dam or cotton rolls

  • Caries removal prior to pulpal access

  • Pulp access with high‐speed bur

  • Pulpotomy amputation with excavator

  • For haemostasis, moistened cotton pellet with water

  • No irrigation

  • Light‐cured CH applied after pulpotomy, before being restored with glass‐ionomer cement and stainless‐steel crown

Outcomes

Clinical success (not clearly defined), radiographic failure (not clearly defined), overall success (the cumulative rate of failure due to clinical abscesses or osseous radiolucencies was calculated for each treatment, as was an overall cumulative rate of success. These calculations were based on the following equation: failure percentage = 100% x (previous failures + new failures)/(previous failures + currently examined teeth)), abscess, internal resorption, internal resorption with perforated form, external resorption, periodontal ligament widening, calcific metamorphosis, bone radiolucency: evaluation at 0 to 6, 7 to 12 and 13 to 24 months (at tooth level)

Notes

3 children were lost due to failure to return for follow‐up

Analysed: 20 children, 68 teeth

Source of funding: quote: "This research project won the Ralph E. MacDonald (sic) Award at the 2006 AAPD annual session for the most outstanding research presented by a graduate student"

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Coin toss

Allocation concealment (selection bias)

Unclear risk

Insufficient information to make a clear judgement

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Insufficient information to make a clear judgement

Blinding of clinical outcomes assessment

Unclear risk

Insufficient information to make a clear judgement

Blinding of radiological outcomes assessment

Low risk

Quote: "...all postoperative radiographs were digitally scanned and evaluated by 2 standardized and calibrated examiners. To blind the examiners to the treatment regimens, the coronal portions were blackened‐out"

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportion of missing outcomes > 10% children randomly assigned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to make a clear judgement

CEM: calcium‐enriched mixture; CH: calcium hydroxide; clin: clinically; EMD: enamel matrix derivative; Er‐YAG: erbium:yttrium‐aluminium garnet; FC: formocresol; FS: ferric sulphate; IRM: intermediate restorative material (reinforced zinc oxide and eugenol); MTA: mineral trioxide aggregate; n: number of teeth; PC: Portland cement; RCT: randomised controlled trial; rx: radiographically; ZOE: zinc oxide and eugenol

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Abdel‐Aziz 1999

Not an RCT

Aktoren 2000

Abstract only. Insufficient information presented. Attempts to contact the authors were unsuccessful

Ansari 2009

Abstract only. Insufficient information presented. Attempts to contact the authors were unsuccessful

Ayrton 1969

Not an RCT

Badzian‐Kobos 1967

Not an RCT

Barcelos 2011

Biomaterials not compared

Beaver 1966

Not an RCT

Berrebi 2009

Abstract only. Insufficient information presented. Attempts to contact the authors were unsuccessful

Boggs 1969

Not an RCT

Brannstrom 1979

Human and dog permanent teeth. In vitro study

Casas 2003

Abstract only. Insufficient information presented. Attempts to contact the authors were unsuccessful

Chien 2001

Not an RCT

Cuisia 2001

Abstract only. Insufficient information presented. Attempts to contact the authors were unsuccessful

Damle 1999

Not an RCT

Droter 1967

Review

Einwag 1991

Not an RCT

Elomaa 1974

Not an RCT

Fuks 2000

Abstract only. Insufficient information presented. Attempts to obtain further information from the authors were unsuccessful

Grivu 1966

Not an RCT

Hannah 1972

Not an RCT

Hansen 1971

Not an RCT

Hartsook 1966

Review

Ibricevic 2001

Abstract only. Insufficient information presented. Attempts to contact the authors were unsuccessful

Kalaskar 2004

Not an RCT

Keszler 1987

Not an RCT

Kouri 1969

Not an RCT

Liu 2003

Abstract only. Insufficient information presented. Attempts to contact the authors were unsuccessful

Liu 2006

Not an RCT

Lourenço 2015

Duplicate

Louwakul 2011

Biomaterials not compared

Mani 1999

Not an RCT

Massler 1968

Not an RCT

Mejare 1979

Restorative dentistry

NCT01622153

Ongoing trial comparing pulpotomy formocresol with electrical pulpotomy, which was terminated because use of one of the materials was discontinued

Odabas 2007

Not an RCT

Percinoto 2006

Not an RCT

Punwani 1993

Abstract only. Insufficient information presented. Attempts to contact the authors were unsuccessful

Ram 2001

Abstract only. Insufficient information presented. Attempts to contact the authors were unsuccessful

Ravn 1968

Not an RCT

Reddy 1996

Abstract only. Insufficient information presented. Attempts to contact the authors were unsuccessful

Redig 1968

Not an RCT

Riccioli 1971

Case report

Ripa 1971

Review

Ritwik 2003

Abstract only. Insufficient information presented. Attempts to contact the authors were unsuccessful

Rivera 2003

Not an RCT

Rocha 1999

Abstract only. Insufficient information presented. Attempts to contact the authors were unsuccessful

Rule 1966

Case report

Sargenti 1975

Review

Sayegh 1967

Not an RCT. Intact human teeth

Sogbe de Agell 1989

Not an RCT

Szabo 1968

Abstract only. Insufficient information presented. Attempts to contact the authors were unsuccessful

Tsai 1993

Not an RCT

Velkova 1977

Not an RCT

Yakushiji 1969

Not an RCT

Yildiz 2014

Not an RCT

Abbreviation ‐ RCT: randomised controlled trial

Characteristics of ongoing studies [ordered by study ID]

CTRI/2011/06/001776

Trial name or title

Root Canal Treatment in Milk Teeth using Three Root Canal Filling Materials: a Double‐Blinded Randomized Controlled Trial

Methods

RCT with participant and outcome assessor blinding

Participants

Inclusion criteria

  • Age 4 to 9 years

  • Non vital teeth

  • Teeth with mild or moderate mobility (grade I and II)

  • Teeth with deep carious lesion and exposures of pulp

  • Patients with the history of spontaneous pain

  • Teeth showing adequate bone support and root length

  • Teeth with no radiographically discernable internal or pathological

  • external resorption

  • Teeth with inter‐radicular and peri‐radicular radiolucencies

Exclusion criteria

  • Any medical history

Interventions

RC fill
Pulpdent root canal sealer
Vitapex

Outcomes

Clinical evaluation: pain, redness, swelling/abscess, draining fistula and mobility
Radiographic evaluation: furcation radiolucency, periapical radiolucency, internal/external root resorption, deviated eruption of succedaneous teeth, excessive filling material and its resorption

Clinical and radiographic evaluation of three root filling materials for a period of 3,6 and 12 months

Starting date

10 June 2011 first recruitment

Contact information

Dr R Pramila (Postgraduate (Pedodontics))
Saveetha Dental College
162 Poonamallee Gigh Road
Velappanchavadi
Chennai
Tamil Nadu
600077
India

[email protected]

Notes

NCT00802256

Trial name or title

Comparative Evaluation of Pulpotomized Primary Molars With Mineral Trioxide Aggregate and New Endodonthic Cement

Methods

"Forty patients are selected randomly. Each patient has at least 2 teeth which require pulpotomy treatment. After removing of carious teeth by a low speed round bur and pulp exposure, roof of pulp chamber is removed completely by a high speed 008 fissure bur. Life tissues of pulp are removed by sharp excavator and rinsing with normal saline. Hemostat is achieved and cavity will be cleaned by 0.5% hypo chlorate solution. MTA or NEC material is mixed according to manufacturer instruction and will be placed in pulp chamber and over pulpal canal orifices for at least 1 mm. The light cure glass ionomer is also mixed according to manufacturer instruction and is placed over the A or B material and cured for 40 minutes. The treated tooth will be restored with a stainless steel crown or amalgam filling material."

Participants

Inclusion criteria

  • Vital pulp exposure of teeth with caries or trauma

  • No clinical signs and symptoms like pain, inflammation

  • No radiographic signs and symptoms like: internal resorption, external resorption, furcation involvement, pulp canal obliteration

  • The restorable tooth

  • No dental treatment contraindication

  • 4 to 8 years (child)

Exclusion criteria

  • Systemic diseases

  • Existence of pain, inflammation or sinus tract

  • No patient compliance

Interventions

Experimental A: teeth that are treated with Mineral Trioxide Aggregate (MTA) material

Experimental B: teeth that are treated with new Endodontic Cement (NEC) material

Outcomes

Primary outcome measures: clinical features and radiographic examination
Time frame: six months and one year

Starting date

October 2008

Contact information

Contact: Fatemeh Shekarchi, student

Notes

NCT00972556

Trial name or title

Comparison of Mineral Trioxide Aggregate (MTA) and 20% formocresol in Pulpotomized Human Primary Molars

Methods

  1. Background: Formocresol is the most widely used pulpotomy medicament in the primary dentition. There are concerns associated with this medicament, primarily the carcinogenicity of the chemical and internal resorption of the treated tooth. Recently, MTA has been suggested with preliminary studies showing promising results.

  2. Study design: This is a prospective clinical randomised controlled trial (RCT), which will be performed at Department of Dentistry, National Taiwan University Hospital, to compare the treatment outcomes between MTA and formocresol in pulpotomised human primary molars and to evaluate whether GMTA is a viable alternative to DFC in pulpotomies treatment of human primary molars.

  3. Hypotheses: null hypotheses: there is no clinical, radiographic, or histological difference between GMTA and DFC at six, 12, 18, 24 month post‐treatment when used as a pulp dressing agent in pulpotomised primary molars. Alternative hypotheses: there is a statistically significant difference between GMTA and DFC as a pulpotomy agent. GMTA shows clinical and/or radiographic and/or histological success as a dressing material following pulpotomy in primary human molars and may be a suitable replacement for DFC in primary molar pulpotomy.

  4. Specific aims: the primary aims of this investigation are: compare the clinical and radiographic results of GMTA with DFC pulpotomies on vital human primary molars at six, 12, 18, and 24 months post‐operatively. Assess intraradicular histological changes of the pulpal tissue and root dentin following pulpotomy treatment with GMTA or DFC. The secondary aims of this investigation are: assess the outcome of GMTA by multiple operators that have been calibrated to the methods of mixing and placing the material. Assess whether sex, tooth type, arch, and child's age at time of treatment influence the overall success rate of GMTA pulpotomies. Compare the radiographic success of the two materials based on both the traditional radiographic assessment criteria adopted by the American Academy of Pediatric Dentistry (AAPD) and the alternative radiographic success criteria adopted by Zurn et al. 2000.To serve as a basis for future research in the comparison of GMTA and DFC pulpotomies. This will include larger sample size, longer follow‐up periods, and a collaborative study with UM group (Prof. Jan C. Hu).

Participants

Inclusion criteria

  • Primary first or second molars with normal pulp, reversible, or irreversible pulpitis, that have vital carious pulp exposures due to caries and whose pulp bled upon entering the pulp chamber.

  • Teeth in which haemostasis could be achieved with pressure of a saline dampened sterile cotton pellet prior to medicament/material placement.

  • No clinical symptoms or evidence of pulp degeneration, such as excessive bleeding from the root canal, history of swelling, mobility, or sinus tracts.

  • Children with percussion sensitivity or spontaneous and persistent pain but where haemostasis could be achieved with pressure of sterile cotton pellet.

  • No radiographic signs of internal or external root resorption, inter‐radicular and/or periapical bone destruction, or furcation radiolucency.

  • No more than one‐third physiologic root resorption has occurred.

  • Teeth had not previously been pulpally treated.

  • Teeth deemed to be restorable with posterior stainless steel crowns.

  • 30 months to 10 years (child)

Exclusion criteria

  • Not present

Interventions

  • Drug: Gray Mineral Trioxide Aggregate (GMTA) Once haemorrhage from the pulp chamber is under control using direct pressure of a sterile cotton pellet, pulp stumps are covered with a MTA paste, obtained by mixing 0.2g GMTA powder with sterile water in a powder to liquid ratio of 3:1 in weight. The GMTA will be then immediately covered with a zinc‐oxide eugenol base (IRM) material. Other Name: ProRoot MTA

  • Drug: Diluted (20%) formocresol (DFC). After the pulp haemostasis is achieved with direct pressure of a sterile cotton pellet, a sterile cotton pellet dampened with 20% DFC will be placed in contact with the pulp for 5 minutes, followed by the immediate placement of a zinc‐oxide eugenol base (IRM) material. Other Name: Buckley's Formo Cresol

Outcomes

Primary: clinically and radiographically outcomes (time frame: six, 12, 18, and 24 months);

Secondary: histological outcome (time frame: when the subjective tooth physically exfoliates from oral cavity)

Starting date

September 2009

Contact information

Contact: Yuan‐Ling Lee, PhD, Contact: Hsiao‐Hua Chang, MS

Notes

NCT01010451

Trial name or title

Antimicrobial Pulpotomy of Primary Molars

Methods

None

Participants

Inclusion criteria

  • Healthy children (ASA PS 1)

  • Children presenting one or more primary molar with pulp inflammation or necrosis due to carious lesion and indicated for endodontic therapy

Exclusion criteria

  • Lost to follow‐up

Interventions

  • Procedure: antimicrobial pulpotomy. Pulpotomy of inflamed or necrotic pulp using an antimicrobial paste (chloramphenicol, tetracycline, zinc oxide/eugenol) as medication. Other names: antibacterial pulp therapy/antibacterial pulpotomy/non‐vital pulpotomy

  • Procedure: calcium hydroxide pulpectomy. Pulpectomy of inflamed or necrotic pulp using a calcium hydroxide paste as medication

Outcomes

None

Starting date

August 2000

Contact information

None

Notes

NCT01591278

Trial name or title

MTA and Biodentine in Pulpotomized Primary Molars

Methods

Parallel RCT

Participants

Age 4 to 9 years

Inclusion criteria

  • Molars showing:

    • symptomless exposure of vital pulp by caries

    • no clinical or radiographic evidence of pulp degeneration (excessive bleeding from the root canal, internal root resorption, inter‐radicular and/or furcal bone destruction)

    • the possibility of proper restoration of the teeth

    • no physiological resorption of more than one‐third of the root

Exclusion criteria

  • Presence of systemic pathology and any history of allergic reaction to latex, local anaesthetics or to the constituents of the test pulp dressing agents

Interventions

Biodentine and MTA

Outcomes

Primary

  • Number of molars with clinical success (time frame 12 months)

  • Number of molars with radiographic success (time frame: 6 and 12 months)

Secondary

  • Number of molars with no evidence of radicular radiolucency

  • Number of molars with no evidence of internal resorption

  • Number of molars with no evidence of external resorption

  • Number of molars with no evidence of furcation radiolucency

  • Number of molars with no symptoms of pain

  • Number of molars without swelling

  • Number of molars without fistulation

  • Number of molars without pathological mobility

Time frame for all secondary outcomes: 6 and 12 months

Starting date

March 2012

Contact information

Cristina Cuadros, International University of Catalonia

Notes

NCT01733420

Trial name or title

Biodentine Versus White MTA Pulpotomy

Methods

Parallel RCT

Participants

  • Age 2 to 9 years

  • Children with carious deciduous molars indicated for pulpotomy belonging to the category of ASA I according to the 'American Society of Anaesthesiologists'

  • No known medical history of systemic complications contradicting pulp treatment

  • Indicated for treatment under general anaesthesia due to polycaries/fear/anxiety/very young age

  • Written consent obtained from the parent/guardian after explaining the full details of the treatment procedure and its possible outcomes

Interventions

Experimental: Biodentine

Active comparator: white mineral trioxide aggregate (MTA)

Active comparator: Tempophore

Outcomes

Not provided

Starting date

October 2011

Contact information

Luc Martens, Ghent University

Notes

NCT02137967

Trial name or title

Sodium Hypochlorite Pulpotomies in Primary Molars: Comparison With Conventional 20% Formocresol Pulpotomies

Methods

Formocresol is the most universally taught and most widely used pulpotomy medicament in the primary teeth. However, concerns have been raised over the use of formocresol because of its toxicity and potential carcinogenicity. A substitute for formocresol has been investigated but evidence is lacking to conclude which is the most appropriate technique for pulpotomies in primary teeth. Sodium hypochlorite (NaOCl) has been used in root canal irrigant for more than 80 years, and it is at present the most popular irrigant in root canal treatment. Studies have showed that NaOCl is biological compatible and is a very good antimicrobial solution without being a pulpal irritant. Recent studies using sodium hypochlorite as pulpotomy medicament in primary molars showed promising results. In this project, the investigators propose a randomised clinical trial, which will be performed in Paediatric Dentistry Department of the National Taiwan University Hospital, to compare the treatment outcomes between NaOCl and formocresol in human primary molars needing pulpotomy treatment. The aim of this study is to determining whether NaOCl is a suitable replacement for formocresol in the pulpotomy of human primary molar teeth. To assess this aim, 200 healthy children aged from 2.5 to 9 years, who have at least one primary first or second molars diagnosed to receive pulpotomy treatment will be recruited. The involved teeth will be randomly assigned to the control group (dilute 20% formocresol (DFC)) or experimental group (2.5% NaOCl). At three, six, nine, 12, 15, 18, 21 and 24 months post‐treatment, the randomly assigned teeth will be clinically and radiographically evaluated by blinded independent evaluators to the treatment group. The differences will be statistically analysed using Chi² test, Fisher's exact test, and t‐test, using a statistical significance at P < 0.05.

Participants

Inclusion criteria

  • Healthy, American Society of Anesthesiologists (ASA) Physical Status classification system class I children

  • Age between 2.5 and 9 years old

  • With one or more primary molars need pulpotomy treatment

  • 30 months to 9 years (child)

Exclusion criteria

  • Children younger than 2.5 or older than 9 years of age

Interventions

  • Experimental: NaOCl pulpotomy Use 2.5% NaOCl as pulpotomy medication. Interventions: procedure: NaOCl pulpotomy drug: 2.5% NaOCl

  • Active comparator: formocresol pulpotomy. Use 20% Formocresol as pulpotomy medicament. Interventions: procedure: formocresol pulpotomy. Drug: 20% Formocresol

Outcomes

Primary: change of clinical findings (time frame: at three, six, nine, 12, 15, 18, 21 and 24 months post‐treatment). The outcome will be assessed first by clinical findings. We can discriminate the result are successful or not by scoring the clinical finding from 1 to 4. Criteria for clinical scoring asymptomatic, clinical score = 1 Slight discomfort: percussion sensitivity; mobility > 1 mm but < 2 mm, clinical score = 2 Minor discomfort: long‐lasting chewing sensitivity; gingival swelling; periodontal pocket formation without exudate; mobility> 2 mm but < 3 mm, clinical score = 3 major discomfort: Late pathological changes; spontaneous pain; periodontal pocket formation with exudate; sinus tract; mobility ≧ 3 mm; premature tooth loss due to pathology, clinical score = 4

Secondary: change of radiographic findings (time frame: at three, six, nine, 12, 15, 18, 21 and 24 months post‐treatment). The outcome will be assessed then by radiographic findings. We can discriminate the result are successful or not by scoring the radiographic findings from1 to 5. Criteria for radiographic scoring Dentinal bridge, clinical score = 1, regeneration tissue response No change, clinical score = 2, no pathological changes Pulp canal obliteration, clinical score = 3, slight pathological changes, no clinical significance Periodontal ligament widening, clinical score = 3, slight pathological changes, no clinical significance Internal root resorption (non‐perforated), clinical score = 4, minor pathological changes External root resorption, clinical score = 4, minor pathological changes Internal root resorption (perforated), clinical score = 4, minor pathological changes Peri‐radicular lesion, clinical score = 5, major pathological changes, treatment needed

Starting date

August 2011

Contact information

Hsiao‐Hua Chang, PhD

Notes

NCT02201498

Trial name or title

Randomized Clinical Trial for Primary Molar Pulpotomy, Biodentine versus Formocresol‐ZOE

Methods

None

Participants

Inclusion criteria

  • ASA I and II

  • Less than 1/3 of physiologic root resorption

  • Asymptomatic tooth (with no history of symptoms)

  • No clinical or radiological sign of pathology

  • Vital tooth, with carious pulpal exposure

  • Haemostasis must be obtained simply with pressure in less than 5 min

  • Teeth restored with stainless steel crowns

  • Up to 10 years (child)

Exclusion criteria

  • More than 10 years old

  • Symptomatic tooth (presently or history of symptoms)

  • Previous pulpal treatment on the tooth

  • Necrotic pulp

  • Hyperemic pulp

  • Inadequate operative technique, defective restoration

  • Non diagnostic x‐ray (pre or post treatment)

Interventions

  • Active comparator: Formocresol/OZE Conventional pulpotomy technique, with formocresol and zinc oxide eugenol Intervention: procedure: pulpotomies with Formocresol/OZE and Biodentine

  • Active comparator: Biodentine New technique, with biodentine Intervention: procedure: pulpotomies with Formocresol/OZE and Biodentine

Outcomes

  • Clinical success (time frame: 12 months post treatment)

  • Radiographic success (time frame: 12 months post treatment)

Starting date

September 2014

Contact information

None

Notes

NCT02286648

Trial name or title

Success Rate Evaluation of Miniature Pulpotomy With MTA in Primary Molars

Methods

None

Participants

4 years to 7 years (child)

Inclusion criteria

  • Healthy people (without any systemic disease)

  • Teeth: no clinical or radiographic evidence of pulp degeneration the possibility of proper restoration of the teeth

Exclusion criteria

  • Teeth: excessive bleeding from the exposure site internal root resorption interradicular and/or periapical bone destruction swelling or sinus tract

Interventions

  • Experimental: Mineral Trioxide Aggregate pulpotomy with MTA Intervention: drug: Mineral Trioxide Aggregate

  • Active comparator: Formocresol pulpotomy with formocresol Intervention: drug: Formocresol

Outcomes

Primary: successful outcome of treatment as indicated by clinical signs defined with observation and checklist (time frame: up to 12 months) success or failure of treatment defined with observation and checklist

Secondary: successful outcome of treatment as indicated by radiographic signs defined with observation and checklist (time frame: up to 12 months) success or failure of treatment defined with observation and checklist

Starting date

February 2014

Contact information

None

Notes

NCT02298504

Trial name or title

Vital Pulp Treatment in Primary Teeth

Methods

Paediatric patients having deep decay in primary molars seen at UMMC, UMSOD, and University of Maryland Rehabilitation and Orthopaedic Institute, will be included in the sample. Teeth with deep caries, > 50% into dentin, will be randomly assigned using a table of random numbers to the three treatment groups:

Group 1 pulpotomy with MTA, Group 2 pulpotomy with Biodentine, Group 3 indirect pulp treatment. Treatment will be performed by board certified paediatric dentists or they will directly supervise paediatric dental residents at each site as part of their regular protocol for treating deep caries.

Radiographs will be taken as prescribed in the Guideline for taking Radiographs in Children by the American Academy of Pediatric Dentistry.

Twice‐yearly clinical examinations will be performed by the treating dentists or paediatric dental residents to check for any soft tissue pathology such as abscess or mobility of treated tooth/teeth. If treatment success/failure consensus between the blinded dentists is not reached, a third dentist will be consulted.

The success/failure data will be entered onto spreadsheets and examined statistically using statistical software.

Participants

Inclusion criteria

  • Paediatric patients with deep dental decay in primary molars

  • Teeth with signs and symptoms of reversible pulpitis

  • 2 to 9 years (child)

Exclusion criteria

  • Teeth with clinical symptoms of irreversible pulpitis or pulp necrosis or acute dental infection

  • Children with systemic illness that contraindicated vital pulp treatment such a sickle cell disease

  • Teeth that are not restorable

Interventions

  • Experimental: Indirect pulp cap IDP will be performed for this group Intervention: Drug: Vitrebond

  • Experimental: MTA pulpotomy MTA pulpotomy will be performed for this group Intervention: Drug: Mineral Trioxide Aggregate

  • Experimental: Biodentin pulpotomy Biodentin pulpotomy will be performed for this group Intervention: Drug: Biodentin

Outcomes

  • Clinical success after pulpotomy (time frame: 3 years) No signs of abscess or any swelling related to the tooth, no signs of fistula or other pathology, no signs of pathologic mobility, no post‐operative pain, no pain on palpation or percussion of the tooth

  • Clinical success after indirect pulp cap (time frame: 3 years) No signs of abscess or any swelling related to the tooth, no signs of fistula or other pathology, no signs of pathologic mobility, no post‐operative pain, no pain on palpation or percussion of the tooth

  • Radiographic success after pulpotomy (time frame: 3 years) No signs of root resorption (internal or external), no signs of furcation involvement or periapical radiolucency, no signs of loss of lamina dura, presence of normal appearance of periodontal ligament space

Starting date

November 2015

Contact information

None

Notes

NCT02393326

Trial name or title

Biodentine Partial Pulpotomy of Pulpally Exposed Primary Molars

Methods

  • Prospective

  • Study population: 100 participants

  • Study group: sample comprises mandibular primary molars from boys and girls aged between 3 and 7 years. The children have no systemic diseases according to the medical history supplied by the parents or guardians. The mandibular primary molars in this study are selected according to the following clinical and radiographic criteria. The clinical criteria: the presence of a deep carious lesion, sufficient tooth structure for restoration with a stainless steel crown, no history of spontaneous pain, tenderness to percussion or abnormal mobility, abscess, fistula, or swelling of the gingiva, and with cessation of bleeding after a 2 mm depth of the pulp at the area of the exposure was amputated. The radiographic criteria: a deep carious lesion in close proximity to the pulp without furcation or radicular pathology, obliteration of the pulp and root canal, or internal or external root resorption. Physiologic root resorption, while included in the criteria, could not be more than one‐third of the root length.

  • Clinical technique: all teeth will be treated under local anaesthesia with rubber dam isolation. After caries removal resulted in a pulp exposure, the pulp at the exposed area is amputated to a depth of 2 mm using a water‐cooled high‐speed handpiece with a #330 high‐speed bur. The wound surface is irrigated with sterile saline solution and dried with cotton pellets to avoid clot formation. After homeostasis is obtained, an assistant drew lots to randomly allocate the case to either the PP or the FP treatment group. The child will not know which treatment is assigned to each tooth. For the PP group, biodentine is gently applied to the wound surface, and then covered with reinforced zinc oxide‐eugenol (IRM_; Dentsply). For the FP group, coronal access is obtained using high‐speed handpiece with a #330 high‐speed bur with water spray to further expose the pulp chamber. Following removal of the coronal pulp and achievement of homeostasis, a cotton pellet moistened with formocresol (1: 5 Buckley's solution) is placed on the amputated pulp for 5 min. The pulp stumps is then covered by IRM. After PP or FP treatment, all teeth are restored with a stainless steel crown.

  • Follow‐up: the follow‐up for clinical and radiographic evaluation will be carried out at 6‐month intervals. Treatment is considered a clinical failure if one or more of the following signs are observed: pain, abscess or sinus opening, tenderness upon percussion, or abnormal tooth mobility. For radiographic evaluation, the treatment is rated as a failure when one or more of the following signs are present: furcation or periapical radiolucency, pathologic external root resorption, or internal resorption. The treatment is regarded successful if both the clinical and radiographic evaluation does not indicate any signs of failure.

Participants

Inclusion criteria

  • Clinical criteria: primary molar with a deep carious lesion

  • Sufficient tooth structure for restoration with a stainless steel crown

  • No history of spontaneous pain

  • Tenderness to percussion or abnormal mobility

  • Abscess, fistula, or swelling of the gingiva, and with cessation of bleeding after a 2 mm depth of the pulp at the area of the exposure was amputated.

  • Radiographic criteria: a deep carious lesion in close proximity to the pulp without furcation or radicular pathology

  • Obliteration of the pulp and root canal, or internal or external root resorption

  • Physiologic root resorption, while included in the criteria, could not be more than one‐third of the root length

  • 3 to 7 years

Exclusion criteria

  • Clinical criteria: history of spontaneous pain

  • Tenderness to percussion or abnormal mobility

  • Abscess, fistula, or swelling of the gingiva, no cessation of bleeding after a 2 mm depth of the pulp at the area of the exposure was amputated.

  • Radiographic criteria: tooth with furcation or radicular pathology

  • Obliteration of the pulp and root canal, or internal or external root resorption

  • Physiologic root resorption more than one‐third of the root length

Interventions

  • Experimental: partial pulpotomy with biodentine Biodentine is gently applied to the pulp stumps Interventions: Procedure: partial pulpotomy with biodentine Drug: biodentine

  • Formocresol pulpotomy: a cotton pellet moistened with formocresol (1: 5 Buckley's solution) is placed on the amputated pulp for 5 min. Interventions: Procedure: formocresol pulpotomy Drug: formocresol

Outcomes

Primary

  • Partial pulpotomy clinical success rate (time frame 6‐month intervals, up to 2 years. From date of randomisation until the date of first documented failure or up to 24 months). Treatment is considered a clinical failure if one or more of the following signs are observed: pain, abscess or sinus opening, tenderness upon percussion, or abnormal tooth mobility. The treatment is regarded successful if clinical evaluation does not indicate any signs of failure.

  • Partial pulpotomy radiographic success rate (time frame: 6‐month intervals, up to 2 years. From date of randomisation until the date of first documented failure or up to 24 months). For radiographic evaluation, the treatment is rated as a failure when one or more of the following signs are present: furcation or periapical radiolucency, pathologic external root resorption, or internal resorption. The treatment is regarded successful if radiographic evaluation does not indicate any signs of failure.

Secondary

  • Formocresol pulpotomy clinical success rate [ Time Frame: 6‐month intervals, up to 2 years. From date of randomization until the date of first documented failure or up to 24 months ]Treatment is considered a clinical failure if one or more of the following signs are observed: pain, abscess or sinus opening, tenderness upon percussion, or abnormal tooth mobility. The treatment is regarded successful if clinical evaluation does not indicate any signs of failure.

  • Formocresol pulpotomy radiographic success rate (time frame: 6‐month intervals, up to 2 years. From date of randomisation until the date of first documented failure or up to 24 months). For radiographic evaluation, the treatment is rated as a failure when one or more of the following signs are present: furcation or periapical radiolucency, pathologic external root resorption, or internal resorption. The treatment is regarded successful if radiographic evaluation does not indicate any signs of failure.

Starting date

May 2015

Contact information

Contact: Avia Fux‐Noy, DMD, Contact: Hadas Lemberg, PhD

Notes

NCT02702505

Trial name or title

Success and Color Stability of MTA Pulpotomized Primary Molars: an RCT (MTA)

Methods

This randomised control, split‐mouth trial will use 50 paediatric participants selected from the patient population in the paediatric dental clinics at Baylor College of Dentistry and in select faculty private practices. The study will use a within‐subject control design whereby one tooth will be treated with a pulpotomy using the new formulation of MTA (NeoMTA Plus, Avalon Biomed Inc., Bradenton, FL, USA) and restored with a multi‐surface composite, and the other tooth with an MTA pulpotomy and restored with a SSC; thus, approximately 50 teeth will be treated for each treatment group. The restoration type will be randomised as to which side will receive the SSC or composite using sealed, opaque envelopes. Approximately 50 participants will be needed for the study in order to elicit any significant findings as demonstrated by a power analysis from a similar study.

Participants

Inclusion criteria

  • Children between the ages of 2.5 and 8 years of age.

  • Participant must have two, contralateral primary molars that are matched for type of molar (first or second), size of carious lesion (same level of approximation of carious lesion to the pulp), and arch (maxillary or mandibular) that are treatment planned for a pulpotomy.

  • The teeth selected for the study must be vital and asymptomatic both clinically and radiographically or only display symptoms consistent with reversible pulpitis. The teeth selected for the study must be anticipated to be retained in the mouth for at least two years.

  • Each participant must have an updated medical history form in the dental record, be examined by the operator, and be classified as ASA I or II (in good general health)

Exclusion criteria

  • Teeth with a history of spontaneous pain

  • Teeth with radiographic evidence of internal or external resorption, intraradicular or periapical bone loss, loss of lamina dura, or widening of the periodontal ligament space

Interventions

  • Experimental: NeoMTA The new formulation of MTA (does not contain bismuth oxide) will be used in one tooth receiving a pulpotomy to determine if the colour of the tooth changes over time. The new formulation has received the Food and Drug Administration 510(k) substantial equivalence clearance for Class II dental materials and is equivalent to its MTA predicate (ProRoot, Dentsply Tulsa Dental, Tulsa, OK, USA). Intervention: Biological: NeoMTA

  • ProRoot MTA control group. This group will receive the old formulation of MTA in the pulpotomy and the tooth will receive a full coverage stainless steel crown restoration.Intervention: Other: ProRoot MTA

Outcomes

  • Color stability (time frame: 2 years). Dental intraoral photographs will evaluated

  • Internal resorption (time frame: 2 years). Dental radiographs will be evaluated resorption

  • External resorption (time frame: 2 years). Dental radiographs will be evaluated resorption

  • Bone loss (time frame: 2 years). Dental radiographs will be evaluated for intraradicular or periapical bone loss

  • Widening of periodontal ligament space (time frame: 2 years). Dental radiographs will be evaluated for widening of the PDL space

Starting date

November 2014

Contact information

Carolyn A Kerins, DDS, PhD

Notes

NCT02783911

Trial name or title

Comparison of mineral trioxide aggregate (MTA) and ferric sulfate pulpotomies

Methods

Comparison of clinical and radiographic success between MTA and ferric sulphate pulpotomies for primary molars. Recall appointments are completed six months, nine months and 12 months. Regular recall and follow‐up will be performed for patients who has MTA or ferric sulphate pulpotomies. Clinical and radiographic findings will be recorded.

Participants

Inclusion criteria

  • ASA I, II

  • Primary molars diagnosed with normal or reversible pulpitis with vital carious pulp exposures.

  • Teeth that can have haemostasis can be achieved with pressure.

  • No clinical symptoms.

  • No radiographic signs of internal resorption or external root resorption.

  • Aged 3 to 10 years.

Exclusion criteria

  • Primary molars diagnosed with irreversible pulpitis or necrotic pulp.

  • Teeth that can not achieve haemostasis.

  • Teeth with abscess or fistula.

  • Teeth that have radiographic signs of internal resorption or external resorption.

Interventions

  • Experimental: MTA subject with pulpotomy treated with MTA paste (< 1 g) will be placed on pulp orifice once for the life of the primary teeth

  • Experimental: ferric sulphate subject with pulpotomy treated with ferric sulphate paste (< 1 g) will be placed on pulp orifice once for 15 seconds and removed on primary teeth

Outcomes

Comparison of the clinical and radiographic success between MTA and ferric sulphate pulpotomies in primary molars (time frame: 1 year). At recall visits six, nine and 12 months, blinded clinical examination will be completed by participating faculty members who are calibrated to clinical scaring criteria. Periapical radiographs will be taken and evaluated by 2 paediatric dentists and 1 endodontist, for presence of various pathologies. Scored based on the criteria established by Zurn and Seale 2008. Scores will be transferred to Microsoft Excel. The difference between the two materials will be analysed using the Mann‐Whitney U test, Chi² test and Fisher's exact test. Intra‐ and inter‐rater agreement will be measured for radiographic assessment using Cohen's kappa test

Starting date

April 2016

Contact information

Jung‐Wei Chen, DDS, MS, PhD

Notes

NCT02789423

Trial name or title

Clinical and radiographical evaluation of the effect of Dycal and Biodentine in DPC in primary teeth

Methods

"The aim of the present study is to compare Calcium Hydroxide cement (Dycal) and Calcium Silicate cement (Biodentine)TM as pulp capping agents in primary molars. The objective of this study include the evaluation of clinical and radiographic efficacy of Calcium Hydroxide cement (Dycal) and Calcium Silicate cement (Biodentine), and their response in direct pulp capping treatment on primary molars during a 6‐month follow‐up. After following the proper standardized procedure for direct pulp cap. In the current study direct pulp capping was performed using calcium hydroxide cement (Dycal) and Calcium Silicate cement (Biodentine) on 60 primary teeth of children equally divided between 2 study groups randomly of both sexes aged 4 to 9 years old. Complete case history was recorded in detail and intraoral periapical radiograph was also taken for teeth indicated for direct pulp capping. Written consent was obtained from the parents of participants before starting the procedure. Strict standardised procedure had been followed and the pulp capping agent (Dycal/Biodentine) were applied according to the manufacturer's instructions. Each participant was evaluated clinically and radiographically for any abnormal clinical signs and symptoms at one, three and six months postoperatively. Better results for the success of the study could be relatively enhanced by close attention to rigid criteria for case selection, standardisation of direct pulp capping procedure and meticulous performance of the procedure appear to be prerequisites for successful treatment."

Participants

Inclusion criteria

  • Good health

  • Co‐operative behaviour

  • Informed consent from parents

  • Primary molars with clinically active caries

  • No history of spontaneous pain in teeth

  • Restorable tooth with at least one half of root length present

  • Absence of pathological mobility

  • Absence of tenderness to percussion

  • Normal gingiva and periodontal condition without the sign of pathology such as redness and swelling of vestibule, draining sinus tract or sensitivity to palpate in the vestibule

  • Aged 4 to 9 years (child)

In addition, the teeth treated by direct pulp capping had only a pinpoint mechanical exposure (0.5 mm to 1 mm), for which haemorrhage control could be achieved within two minutes before proceeding with direct pulp capping.

Radiographically, there was absence of internal resorption, external resorption, periapical or furcation radiolucencies and pathology of succedaneous permanent tooth follicle.

Exclusion criteria

  • Children with a history of spontaneous pain, tooth tender to percussion, absence of underlying permanent teeth, internal/external root resorption, apical/furcal lesions, sinus tract, physiologic or pathologic luxation, and/or presence of abscess were excluded from the study.

Interventions

  • Active comparator: Dycal Intervention: drug: Dycal (calcium hydroxide). Intervention description: DPC using Dycal for direct pulp exposure was performed in 30 primary molar teeth after proper case selection. Clinical and radiographic evaluation was done. One month postoperative criteria evaluated were ‐ clinical criteria: spontaneous pain, Defective restoration/Recurrent caries, Sinus formation, TOP, soft tissue swelling and mobility. Radiographic criteria: defective restoration/recurrent caries, periapical or furcal radiolucency, pathological internal resorption, replacement resorption, intracanal calcification and physiological resorption. The follow‐up was at three and six months. Intervention: Procedure: Direct Pulp Capping using Dycal and Biodentine

  • Active comparator: Biodentine Intervention: drug: Biodentine, Other names: Calcium Silicate. Intervention description: DPC using Biodentine for direct pulp exposure was performed in 30 primary molar teeth after proper case selection. Clinical and radiographic evaluation was done. One month post operative criteria were ‐ clinical criteria: spontaneous pain, defective restoration/recurrent caries, sinus formation, TOP, soft tissue swelling and mobility. Radiographic criteria: defective restoration/recurrent caries, periapical or furcal radiolucency, pathological internal resorption, replacement resorption, intracanal calcification and physiological resorption. The follow‐up was at three and six months. Intervention: Procedure: Direct Pulp Capping using Dycal and Biodentine

Outcomes

Evidence of effectiveness of Dycal and Biodentine as Direct Pulp Capping agent in primary molars confirmed by clinical and radiographic evaluation (time frame: 6 months)

Starting date

June 2014

Contact information

Dr Komal IM Gandhi, BDS, Dr Mishthu Solanki, MDS

Notes

Data and analyses

Open in table viewer
Comparison 1. Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

14

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 1.1

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

13

1048

Risk Ratio (M‐H, Fixed, 95% CI)

0.37 [0.07, 1.89]

1.2 12 months

12

740

Risk Ratio (M‐H, Fixed, 95% CI)

0.31 [0.10, 0.93]

1.3 24 months

9

548

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.18, 1.19]

2 Radiological failure Show forest plot

13

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 1.2

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 2 Radiological failure.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

12

922

Risk Ratio (M‐H, Fixed, 95% CI)

0.38 [0.17, 0.86]

2.2 12 months

12

740

Risk Ratio (M‐H, Fixed, 95% CI)

0.41 [0.19, 0.89]

2.3 24 months

9

548

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.22, 0.80]

3 Overall failure Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 1.3

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 3 Overall failure.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 3 Overall failure.

3.1 6 months

6

328

Risk Ratio (M‐H, Fixed, 95% CI)

0.23 [0.04, 1.32]

3.2 12 months

6

328

Risk Ratio (M‐H, Fixed, 95% CI)

0.48 [0.17, 1.36]

3.3 24 months

7

368

Risk Ratio (M‐H, Fixed, 95% CI)

0.50 [0.25, 1.01]

4 Pain Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 1.4

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 4 Pain.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 4 Pain.

4.1 6 months

6

390

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

4.2 12 months

6

410

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.18]

4.3 24 months

4

290

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.14, 3.56]

5 Soft tissue pathology Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 1.5

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 5 Soft tissue pathology.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 5 Soft tissue pathology.

5.1 6 months

7

410

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

5.2 12 months

7

430

Risk Ratio (M‐H, Fixed, 95% CI)

0.22 [0.05, 1.01]

5.3 24 months

5

310

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.04, 3.10]

6 Pathological mobility Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 1.6

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 6 Pathological mobility.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 6 Pathological mobility.

6.1 6 months

5

250

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 12 months

4

200

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.97]

6.3 24 months

3

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Pathological radiolucency Show forest plot

14

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 1.7

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 7 Pathological radiolucency.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 7 Pathological radiolucency.

7.1 6 months

13

1010

Risk Ratio (M‐H, Fixed, 95% CI)

0.54 [0.27, 1.08]

7.2 12 months

11

652

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.19, 0.98]

7.3 24 months

8

460

Risk Ratio (M‐H, Fixed, 95% CI)

0.55 [0.25, 1.22]

8 Pathological root resorption Show forest plot

12

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 1.8

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 8 Pathological root resorption.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 8 Pathological root resorption.

8.1 6 months

11

866

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.18, 1.21]

8.2 12 months

9

508

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.07, 1.03]

8.3 24 months

6

338

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.08, 0.81]

9 Pulp canal obliteration Show forest plot

9

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 1.9

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 9 Pulp canal obliteration.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 9 Pulp canal obliteration.

9.1 6 months

9

712

Risk Ratio (M‐H, Fixed, 95% CI)

1.52 [1.00, 2.30]

9.2 12 months

7

410

Risk Ratio (M‐H, Fixed, 95% CI)

1.70 [0.81, 3.57]

9.3 24 months

6

338

Risk Ratio (M‐H, Fixed, 95% CI)

2.05 [1.07, 3.94]

10 Dentin bridge formation Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 1.10

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 10 Dentin bridge formation.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 10 Dentin bridge formation.

10.1 6 months

3

322

Risk Ratio (M‐H, Fixed, 95% CI)

18.16 [3.63, 90.91]

10.2 12 months

2

70

Risk Ratio (M‐H, Fixed, 95% CI)

6.0 [0.76, 47.22]

10.3 24 months

2

70

Risk Ratio (M‐H, Fixed, 95% CI)

6.0 [0.76, 47.22]

11 Physiological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 1.11

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 11 Physiological root resorption.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 11 Physiological root resorption.

11.1 6 months

2

170

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.2 12 months

2

170

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.3 24 months

2

170

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.81]

Open in table viewer
Comparison 2. Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 2.1

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

6

538

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.09, 5.64]

1.2 12 months

5

432

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.12, 1.68]

1.3 24 months

3

290

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.04, 3.14]

2 Radiological failure Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 2.2

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 2 Radiological failure.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

4

362

Risk Ratio (M‐H, Fixed, 95% CI)

0.29 [0.05, 1.79]

2.2 12 months

5

432

Risk Ratio (M‐H, Fixed, 95% CI)

0.28 [0.08, 0.98]

2.3 24 months

3

290

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.06, 0.67]

3 Pain Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 2.3

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 3 Pain.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 3 Pain.

3.1 6 months

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

3.2 12 months

3

260

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.18]

3.3 24 months

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.04, 3.14]

4 Soft tissue pathology Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 2.4

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 4 Soft tissue pathology.

4.1 6 months

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

4.2 12 months

3

260

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.18]

4.3 24 months

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

5 Pathological radiolucency Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 2.5

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 5 Pathological radiolucency.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 5 Pathological radiolucency.

5.1 6 months

4

388

Risk Ratio (M‐H, Fixed, 95% CI)

0.16 [0.01, 2.95]

5.2 12 months

4

332

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.16, 2.38]

5.3 24 months

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.11, 1.95]

6 Pathological root resorption Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 2.6

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 6 Pathological root resorption.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 6 Pathological root resorption.

6.1 6 months

3

316

Risk Ratio (M‐H, Fixed, 95% CI)

0.11 [0.01, 1.95]

6.2 12 months

3

260

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

6.3 24 months

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.13 [0.02, 0.98]

7 Pulp canal obliteration Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 2.7

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 7 Pulp canal obliteration.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 7 Pulp canal obliteration.

7.1 6 months

2

192

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.2 12 months

2

192

Risk Ratio (M‐H, Fixed, 95% CI)

12.76 [0.79, 206.70]

Open in table viewer
Comparison 3. Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 3.1

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

8

560

Risk Ratio (M‐H, Fixed, 95% CI)

0.16 [0.01, 3.06]

1.2 12 months

7

308

Risk Ratio (M‐H, Fixed, 95% CI)

0.16 [0.02, 1.28]

1.3 24 months

6

258

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.18, 1.42]

2 Radiological failure Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 3.2

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 2 Radiological failure.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

8

560

Risk Ratio (M‐H, Fixed, 95% CI)

0.41 [0.17, 1.03]

2.2 12 months

7

308

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.20, 1.53]

2.3 24 months

6

258

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.31, 1.46]

3 Pain Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 3.3

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 3 Pain.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 3 Pain.

3.1 6 months

4

200

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 12 months

3

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 24 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 70.30]

4 Soft tissue pathology Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 3.4

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 4 Soft tissue pathology.

4.1 6 months

5

220

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 12 months

4

170

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.02, 1.65]

4.3 24 months

3

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.72]

5 Pathological mobility Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 3.5

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 5 Pathological mobility.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 5 Pathological mobility.

5.1 6 months

4

180

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.97]

5.3 24 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Pathological radiolucency Show forest plot

9

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 3.6

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 6 Pathological radiolucency.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 6 Pathological radiolucency.

6.1 6 months

9

622

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.30, 1.27]

6.2 12 months

7

320

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.13, 1.02]

6.3 24 months

6

270

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.23, 1.57]

7 Pathological root resorption Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 3.7

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 7 Pathological root resorption.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 7 Pathological root resorption.

7.1 6 months

8

550

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.24, 1.99]

7.2 12 months

6

248

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.05, 1.14]

7.3 24 months

4

148

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.10, 1.92]

8 Pulp canal obliteration Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 3.8

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 8 Pulp canal obliteration.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 8 Pulp canal obliteration.

8.1 6 months

7

520

Risk Ratio (M‐H, Fixed, 95% CI)

1.52 [1.00, 2.30]

8.2 12 months

5

218

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.44, 2.26]

8.3 24 months

5

218

Risk Ratio (M‐H, Fixed, 95% CI)

1.97 [0.99, 3.89]

Open in table viewer
Comparison 4. Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 4.1

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 1 Clinical failure.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

4

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.08 [0.00, 1.31]

1.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.97]

1.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.52 [0.20, 1.39]

2 Radiological failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 4.2

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 2 Radiological failure.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

4

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.06 [0.01, 0.40]

2.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.15, 3.44]

2.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.25, 1.36]

3 Overall failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 4.3

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 3 Overall failure.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 3 Overall failure.

3.1 6 months

4

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.06 [0.01, 0.40]

3.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.15, 3.44]

3.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.32, 1.89]

4 Pain Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 4.4

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 4 Pain.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 4 Pain.

4.1 6 months

3

160

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.00]

4.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Soft tissue pathology Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 4.5

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 5 Soft tissue pathology.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 5 Soft tissue pathology.

5.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.00]

6 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 4.6

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 6 Pathologic mobility.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 6 Pathologic mobility.

6.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.08 [0.00, 1.31]

7 Pathologic radiolucency Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 4.7

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 7 Pathologic radiolucency.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 7 Pathologic radiolucency.

7.1 6 months

3

160

Risk Ratio (M‐H, Fixed, 95% CI)

0.03 [0.00, 0.48]

7.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.81]

7.3 24 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.97]

8 Pathological root resorption Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 4.8

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 8 Pathological root resorption.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 8 Pathological root resorption.

8.1 6 months

4

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.07 [0.01, 0.53]

8.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.97]

8.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.12, 2.51]

9 Pulp canal obliteration Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 4.9

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 9 Pulp canal obliteration.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 9 Pulp canal obliteration.

9.1 6 months

3

140

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.2 12 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 70.30]

9.3 24 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

1.57 [0.47, 5.27]

Open in table viewer
Comparison 5. Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 5.1

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 1 Clinical failure.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

4

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.85]

1.2 12 months

4

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.16 [0.04, 0.70]

1.3 24 months

5

284

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.12, 0.52]

2 Radiological failure Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 5.2

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 2 Radiological failure.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

4

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.08 [0.02, 0.41]

2.2 12 months

4

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.12 [0.04, 0.36]

2.3 24 months

5

284

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.08, 0.26]

3 Overall failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 5.3

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 3 Overall failure.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 3 Overall failure.

3.1 6 months

2

68

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.92]

3.2 12 months

2

68

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.10, 1.19]

3.3 24 months

2

68

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.18, 0.95]

4 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 5.4

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 4 Pain.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 4 Pain.

4.1 24 months

2

196

Risk Ratio (M‐H, Fixed, 95% CI)

0.41 [0.09, 1.73]

5 Soft tissue pathology Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 5.5

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 5 Soft tissue pathology.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 5 Soft tissue pathology.

5.1 6 months

3

122

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.02, 1.62]

5.2 12 months

3

122

Risk Ratio (M‐H, Fixed, 95% CI)

0.12 [0.02, 0.62]

5.3 24 months

4

256

Risk Ratio (M‐H, Fixed, 95% CI)

0.17 [0.06, 0.47]

6 Pathological mobility Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 5.6

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 6 Pathological mobility.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 6 Pathological mobility.

6.1 6 months

3

122

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.02, 1.62]

6.2 12 months

3

122

Risk Ratio (M‐H, Fixed, 95% CI)

0.09 [0.01, 0.66]

6.3 24 months

4

256

Risk Ratio (M‐H, Fixed, 95% CI)

0.09 [0.01, 0.66]

7 Pathological radiolucency Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 5.7

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 7 Pathological radiolucency.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 7 Pathological radiolucency.

7.1 6 months

4

162

Risk Ratio (M‐H, Fixed, 95% CI)

0.10 [0.02, 0.50]

7.2 12 months

4

162

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.04, 0.47]

7.3 24 months

5

296

Risk Ratio (M‐H, Fixed, 95% CI)

0.08 [0.03, 0.22]

8 Pathological root resorption Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 5.8

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 8 Pathological root resorption.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 8 Pathological root resorption.

8.1 6 months

5

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.10 [0.02, 0.39]

8.2 12 months

5

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.07 [0.02, 0.29]

8.3 24 months

6

324

Risk Ratio (M‐H, Fixed, 95% CI)

0.08 [0.03, 0.18]

9 Pulp canal obliteration Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 5.9

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 9 Pulp canal obliteration.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 9 Pulp canal obliteration.

9.1 6 months

3

120

Risk Ratio (M‐H, Fixed, 95% CI)

7.77 [1.56, 38.69]

9.2 12 months

3

120

Risk Ratio (M‐H, Fixed, 95% CI)

2.01 [0.97, 4.17]

9.3 24 months

4

254

Risk Ratio (M‐H, Fixed, 95% CI)

2.05 [1.01, 4.19]

10 Dentin bridge formation Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 5.10

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 10 Dentin bridge formation.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 10 Dentin bridge formation.

10.1 6 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.05, 0.84]

10.2 12 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.8 [0.37, 1.74]

10.3 24 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.8 [0.37, 1.74]

Open in table viewer
Comparison 6. Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 6.1

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 1 Clinical failure.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.02]

1.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.02]

1.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.02]

2 Radiological failure Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 6.2

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 2 Radiological failure.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.10, 2.56]

3 Pain Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 6.3

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 3 Pain.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 3 Pain.

3.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

3.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

3.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

4 Soft tissue pathology Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 6.4

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 4 Soft tissue pathology.

4.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.02]

4.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.02]

4.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.02]

5 Pathologic mobility Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 6.5

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 5 Pathologic mobility.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 5 Pathologic mobility.

5.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

5.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

5.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

6 Pathological radiolucency Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 6.6

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 6 Pathological radiolucency.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 6 Pathological radiolucency.

6.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.12, 3.75]

7 Pathological root resorption Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 6.7

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 7 Pathological root resorption.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 7 Pathological root resorption.

7.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

8 Pulp canal obliteration Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 6.8

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 8 Pulp canal obliteration.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 8 Pulp canal obliteration.

8.1 6 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.49, 1.08]

8.2 12 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.60, 1.14]

8.3 24 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.71, 1.29]

9 Dentin bridge formation Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 6.9

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 9 Dentin bridge formation.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 9 Dentin bridge formation.

9.1 6 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.13, 2.43]

9.2 12 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.61, 3.71]

9.3 24 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.61, 3.71]

Open in table viewer
Comparison 7. Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 7.1

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 1 Clinical failure.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

4

234

Risk Ratio (M‐H, Fixed, 95% CI)

1.72 [0.42, 6.99]

1.2 12 months

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.16, 3.62]

2 Radiological failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 7.2

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 2 Radiological failure.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

4

234

Risk Ratio (M‐H, Fixed, 95% CI)

2.40 [0.65, 8.84]

2.2 12 months

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.22, 5.27]

3 Pain Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 7.3

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 3 Pain.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 3 Pain.

3.1 6 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.26, 98.00]

4 Soft tissue pathology Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 7.4

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 4 Soft tissue pathology.

4.1 6 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.26, 98.00]

5 Pathologic mobility Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 7.5

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 5 Pathologic mobility.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 5 Pathologic mobility.

5.1 6 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.26, 98.00]

6 Pathological radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 7.6

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 6 Pathological radiolucency.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 6 Pathological radiolucency.

6.1 6 months

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

3.46 [0.15, 81.36]

6.2 12 months

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.19, 6.27]

7 Pathological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 7.7

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 7 Pathological root resorption.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 7 Pathological root resorption.

7.1 6 months

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

2.32 [0.22, 24.09]

7.2 12 months

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.30, 4.19]

Open in table viewer
Comparison 8. Calcium hydroxide pulpotomy versus formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 8.1

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

6

332

Risk Ratio (M‐H, Fixed, 95% CI)

1.98 [1.17, 3.37]

1.2 12 months

6

332

Risk Ratio (M‐H, Fixed, 95% CI)

1.87 [1.22, 2.89]

1.3 24 months

3

150

Risk Ratio (M‐H, Fixed, 95% CI)

2.18 [0.78, 6.11]

2 Radiological failure Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 8.2

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 2 Radiological failure.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

4

154

Risk Ratio (M‐H, Fixed, 95% CI)

15.48 [3.86, 62.06]

2.2 12 months

6

332

Risk Ratio (M‐H, Fixed, 95% CI)

1.86 [1.42, 2.44]

2.3 24 months

3

150

Risk Ratio (M‐H, Fixed, 95% CI)

3.63 [1.73, 7.61]

3 Overall failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 8.3

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 3 Overall failure.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 3 Overall failure.

3.1 12 months

2

120

Risk Ratio (M‐H, Fixed, 95% CI)

2.41 [0.80, 7.21]

3.2 24 months

2

120

Risk Ratio (M‐H, Fixed, 95% CI)

2.93 [1.35, 6.34]

4 Pain Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 8.4

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 4 Pain.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 4 Pain.

4.1 6 months

4

276

Risk Ratio (M‐H, Fixed, 95% CI)

3.18 [0.35, 29.08]

4.2 12 months

4

276

Risk Ratio (M‐H, Fixed, 95% CI)

6.30 [1.15, 34.40]

5 Soft tissue pathology Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 8.5

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 5 Soft tissue pathology.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 5 Soft tissue pathology.

5.1 6 months

5

306

Risk Ratio (M‐H, Fixed, 95% CI)

5.14 [0.63, 42.25]

5.2 12 months

5

306

Risk Ratio (M‐H, Fixed, 95% CI)

6.77 [1.23, 37.10]

5.3 24 months

2

124

Risk Ratio (M‐H, Fixed, 95% CI)

2.64 [0.51, 13.55]

6 Pathological mobility Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 8.6

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 6 Pathological mobility.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 6 Pathological mobility.

6.1 6 months

4

238

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.18, 8.19]

6.2 12 months

4

238

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.40, 3.31]

6.3 24 months

2

124

Risk Ratio (M‐H, Fixed, 95% CI)

9.0 [0.53, 153.79]

7 Pathological radiolucency Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 8.7

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 7 Pathological radiolucency.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 7 Pathological radiolucency.

7.1 6 months

3

128

Risk Ratio (M‐H, Fixed, 95% CI)

3.78 [0.64, 22.17]

7.2 12 months

5

306

Risk Ratio (M‐H, Fixed, 95% CI)

1.90 [0.67, 5.40]

7.3 24 months

2

124

Risk Ratio (M‐H, Fixed, 95% CI)

3.24 [0.79, 13.28]

8 Pathological root resorption Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 8.8

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 8 Pathological root resorption.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 8 Pathological root resorption.

8.1 6 months

4

154

Risk Ratio (M‐H, Fixed, 95% CI)

11.87 [2.33, 60.40]

8.2 12 months

6

332

Risk Ratio (M‐H, Fixed, 95% CI)

6.25 [2.04, 19.14]

8.3 24 months

3

150

Risk Ratio (M‐H, Fixed, 95% CI)

4.59 [1.33, 15.81]

9 Pulp canal obliteration Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 8.9

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 9 Pulp canal obliteration.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 9 Pulp canal obliteration.

9.1 6 months

2

56

Risk Ratio (M‐H, Fixed, 95% CI)

4.0 [0.47, 33.75]

9.2 12 months

3

140

Risk Ratio (M‐H, Fixed, 95% CI)

2.68 [0.91, 7.95]

10 Dentin bridge formation Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 8.10

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 10 Dentin bridge formation.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 10 Dentin bridge formation.

10.1 6 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

13.0 [1.81, 93.60]

10.2 12 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

14.0 [1.95, 100.26]

Open in table viewer
Comparison 9. Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 9.1

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 1 Clinical failure.

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

3.4 [0.14, 81.38]

1.2 12 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

3.41 [0.37, 31.61]

1.3 24 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

3.44 [0.90, 13.18]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 9.2

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 2 Radiological failure.

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 2 Radiological failure.

2.1 12 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.53, 3.13]

2.2 24 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

1.97 [1.04, 3.75]

3 Overall failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 9.3

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 3 Overall failure.

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 3 Overall failure.

3.1 12 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.53, 3.13]

3.2 24 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

1.97 [1.04, 3.75]

4 Pathological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 9.4

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 4 Pathological root resorption.

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 4 Pathological root resorption.

4.1 12 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.05, 6.05]

4.2 24 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

2.29 [0.60, 8.66]

Open in table viewer
Comparison 10. Ferric sulphate pulpotomy versus formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 10.1

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

7

394

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.15, 6.87]

1.2 12 months

7

394

Risk Ratio (M‐H, Fixed, 95% CI)

1.38 [0.45, 4.27]

1.3 24 months

5

258

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.40, 1.70]

2 Radiological failure Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 10.2

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 2 Radiological failure.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

6

294

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.32, 1.92]

2.2 12 months

7

394

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.73, 2.42]

2.3 24 months

5

258

Risk Ratio (M‐H, Fixed, 95% CI)

1.26 [0.71, 2.24]

3 Overall failure Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 10.3

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 3 Overall failure.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 3 Overall failure.

3.1 6 months

4

184

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.12, 2.37]

3.2 12 months

5

284

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.51, 2.64]

3.3 24 months

4

228

Risk Ratio (M‐H, Fixed, 95% CI)

1.49 [0.74, 3.01]

4 Pain Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 10.4

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 4 Pain.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 4 Pain.

4.1 6 months

4

230

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.58]

4.2 12 months

4

230

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.58]

4.3 24 months

4

230

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.85]

5 Pathological radiolucency Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 10.5

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 5 Pathological radiolucency.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 5 Pathological radiolucency.

5.1 12 months

4

230

Risk Ratio (M‐H, Fixed, 95% CI)

1.8 [0.40, 8.17]

5.2 24 months

4

230

Risk Ratio (M‐H, Fixed, 95% CI)

2.2 [0.51, 9.50]

6 Pathological root resorption Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 10.6

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 6 Pathological root resorption.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 6 Pathological root resorption.

6.1 6 months

5

214

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.12, 3.84]

6.2 12 months

6

314

Risk Ratio (M‐H, Fixed, 95% CI)

1.64 [0.53, 5.08]

6.3 24 months

5

258

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.50, 2.96]

7 Pulp canal obliteration Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 10.7

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 7 Pulp canal obliteration.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 7 Pulp canal obliteration.

7.1 6 months

3

134

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.2 12 months

3

134

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.54, 1.64]

7.3 24 months

2

78

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.28, 5.54]

Open in table viewer
Comparison 11. Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 11.1

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 1 Clinical failure.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

4.39 [0.22, 87.82]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 11.2

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 2 Radiological failure.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.55 [0.22, 1.39]

2.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.17, 1.02]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 11.3

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 3 Pain.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 3 Pain.

3.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Soft tissue pathology Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 11.4

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 4 Soft tissue pathology.

4.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.29 [0.01, 6.91]

5 Adjacent tissue inflammation Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 11.5

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 5 Adjacent tissue inflammation.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 5 Adjacent tissue inflammation.

5.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.31 [0.03, 2.91]

6 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 11.6

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 6 Pathologic mobility.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 6 Pathologic mobility.

6.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Pathologic radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 11.7

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 7 Pathologic radiolucency.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 7 Pathologic radiolucency.

7.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.06, 13.35]

7.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.07, 4.17]

8 Pathologic root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 11.8

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 8 Pathologic root resorption.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 8 Pathologic root resorption.

8.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.18, 1.42]

8.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.38 [0.15, 1.01]

Open in table viewer
Comparison 12. Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 12.1

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 1 Clinical failure.

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.23 [0.04, 1.30]

1.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.02, 1.62]

2 Radiological failure Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 12.2

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 2 Radiological failure.

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.38, 2.12]

2.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.44, 1.92]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 12.3

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 3 Pain.

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 3 Pain.

3.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.03, 1.60]

4 Pathological radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 12.4

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 4 Pathological radiolucency.

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 4 Pathological radiolucency.

4.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.08]

5 Pathological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 12.5

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 5 Pathological root resorption.

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 5 Pathological root resorption.

5.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.29, 7.73]

Open in table viewer
Comparison 13. Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 13.1

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 1 Clinical failure.

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.13, 2.34]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 13.2

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 2 Radiological failure.

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.38, 4.12]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 13.3

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 3 Pain.

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 3 Pain.

3.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.13, 2.34]

4 Pathological mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 13.4

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 4 Pathological mobility.

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 4 Pathological mobility.

4.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Pathological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 13.5

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 5 Pathological root resorption.

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 5 Pathological root resorption.

5.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

2.2 [0.54, 8.88]

6 Pulp canal obliteration Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 13.6

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 6 Pulp canal obliteration.

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 6 Pulp canal obliteration.

6.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 14. Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 14.1

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 1 Clinical failure.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.37, 4.27]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 14.2

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 2 Radiological failure.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.16, 6.20]

2.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.34, 2.23]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 14.3

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 3 Pain.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 3 Pain.

3.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.15, 6.71]

4 Soft tissue pathology Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 14.4

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 4 Soft tissue pathology.

4.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.27, 8.43]

5 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 14.5

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 5 Pathologic mobility.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 5 Pathologic mobility.

5.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Pathologic radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 14.6

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 6 Pathologic radiolucency.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 6 Pathologic radiolucency.

6.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.12, 3.75]

7 Pathologic root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 14.7

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 7 Pathologic root resorption.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 7 Pathologic root resorption.

7.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.26, 96.13]

7.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.31, 3.23]

Open in table viewer
Comparison 15. Diode laser pulpotomy versus electrosurgery pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 15.1

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 1 Clinical failure.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.70]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 15.2

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 2 Radiological failure.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.19, 2.18]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 15.3

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 3 Pain.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 3 Pain.

3.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.70]

4 Pathological mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 15.4

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 4 Pathological mobility.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 4 Pathological mobility.

4.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Pathological radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 15.5

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 5 Pathological radiolucency.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 5 Pathological radiolucency.

5.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Pathological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 15.6

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 6 Pathological root resorption.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 6 Pathological root resorption.

6.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.19, 2.18]

7 Pulp canal obliteration Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 15.7

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 7 Pulp canal obliteration.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 7 Pulp canal obliteration.

7.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 16. Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 16.1

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 16.2

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 2 Radiological failure.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 2 Radiological failure.

2.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.33, 5.08]

2.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.86 [0.52, 6.59]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 16.3

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 3 Pain.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 3 Pain.

3.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Soft tissue pathology Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 16.4

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 4 Soft tissue pathology.

4.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 16.5

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 5 Pathologic mobility.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 5 Pathologic mobility.

5.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Pathologic radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 16.6

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 6 Pathologic radiolucency.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 6 Pathologic radiolucency.

6.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Pathologic root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 16.7

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 7 Pathologic root resorption.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 7 Pathologic root resorption.

7.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.33, 5.08]

7.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.86 [0.52, 6.59]

Open in table viewer
Comparison 17. Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 17.1

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 1 Clinical failure.

1.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.8 [0.23, 2.83]

2 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 17.2

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 2 Pain.

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 2 Pain.

2.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.4 [0.08, 1.92]

3 Soft tissue pathology Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 17.3

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 3 Soft tissue pathology.

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 3 Soft tissue pathology.

3.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

2.0 [0.19, 21.06]

4 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 17.4

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 4 Pathologic mobility.

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 4 Pathologic mobility.

4.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.26, 96.13]

Open in table viewer
Comparison 18. Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 18.1

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 1 Radiological failure.

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 1 Radiological failure.

1.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

2.5 [0.50, 12.50]

2 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 18.2

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 2 Pain.

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 2 Pain.

2.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.14, 6.90]

3 Pathological mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 18.3

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 3 Pathological mobility.

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 3 Pathological mobility.

3.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.14, 6.90]

4 Pathological radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 18.4

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 4 Pathological radiolucency.

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 4 Pathological radiolucency.

4.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.26, 8.72]

5 Pathological radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 18.5

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 5 Pathological radiolucency.

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 5 Pathological radiolucency.

5.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.08]

Open in table viewer
Comparison 19. Metapex versus zinc oxide eugenol (ZOE) pulpectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 19.1

Comparison 19 Metapex versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 1 Clinical failure.

Comparison 19 Metapex versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 1 Clinical failure.

1.1 6 months

2

62

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.08, 4.29]

1.2 12 months

2

62

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.15, 3.33]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 19.2

Comparison 19 Metapex versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 2 Radiological failure.

Comparison 19 Metapex versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 2 Radiological failure.

2.1 6 months

2

62

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.31, 3.27]

2.2 12 months

2

62

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.31, 3.27]

Open in table viewer
Comparison 20. Metapex pulpectomy versus Endoflas pulpectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clincal failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 20.1

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 1 Clincal failure.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 1 Clincal failure.

1.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.58]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 20.2

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 2 Radiological failure.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 2 Radiological failure.

2.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

2.02 [0.79, 5.15]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 20.3

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 3 Pain.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 3 Pain.

3.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.58]

4 Soft tissue pathology Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 20.4

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 4 Soft tissue pathology.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 4 Soft tissue pathology.

4.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.58]

5 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 20.5

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 5 Pathologic mobility.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 5 Pathologic mobility.

5.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Pathological radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 20.6

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 6 Pathological radiolucency.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 6 Pathological radiolucency.

6.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

2.02 [0.79, 5.15]

7 Pathological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 20.7

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 7 Pathological root resorption.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 7 Pathological root resorption.

7.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 21. Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 21.1

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 1 Clinical failure.

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 1 Clinical failure.

1.1 6 months

4

287

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.84]

1.2 12 months

4

287

Risk Ratio (M‐H, Fixed, 95% CI)

4.75 [1.21, 18.55]

2 Radiological failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 21.2

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 2 Radiological failure.

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 2 Radiological failure.

2.1 6 months

4

287

Risk Ratio (M‐H, Fixed, 95% CI)

2.36 [0.86, 6.50]

2.2 12 months

4

287

Risk Ratio (M‐H, Fixed, 95% CI)

6.56 [2.58, 16.67]

3 Overall failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 21.3

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 3 Overall failure.

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 3 Overall failure.

3.1 6 months

2

140

Risk Ratio (M‐H, Fixed, 95% CI)

1.89 [0.63, 5.66]

3.2 12 months

2

140

Risk Ratio (M‐H, Fixed, 95% CI)

2.56 [0.89, 7.32]

4 Pain Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 21.4

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 4 Pain.

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 4 Pain.

4.1 6 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 12 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Pathological mobility Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 21.5

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 5 Pathological mobility.

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 5 Pathological mobility.

5.1 6 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.84]

5.2 12 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.07, 15.18]

Open in table viewer
Comparison 22. Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 22.1

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 1 Clinical failure.

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 1 Clinical failure.

1.1 6 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.05, 1.50]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 22.2

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 2 Radiological failure.

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 2 Radiological failure.

2.1 6 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.05, 1.50]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 22.3

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 3 Pain.

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 3 Pain.

3.1 6 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.05, 1.50]

4 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 22.4

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 4 Pathologic mobility.

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 4 Pathologic mobility.

4.1 6 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.16 [0.02, 1.25]

5 Pathologic radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Analysis 22.5

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 5 Pathologic radiolucency.

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 5 Pathologic radiolucency.

5.1 6 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.11, 3.63]

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 1.1

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 1.2

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 2 Radiological failure.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 3 Overall failure.
Figures and Tables -
Analysis 1.3

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 3 Overall failure.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 4 Pain.
Figures and Tables -
Analysis 1.4

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 4 Pain.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 5 Soft tissue pathology.
Figures and Tables -
Analysis 1.5

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 5 Soft tissue pathology.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 6 Pathological mobility.
Figures and Tables -
Analysis 1.6

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 6 Pathological mobility.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 7 Pathological radiolucency.
Figures and Tables -
Analysis 1.7

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 7 Pathological radiolucency.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 8 Pathological root resorption.
Figures and Tables -
Analysis 1.8

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 8 Pathological root resorption.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 9 Pulp canal obliteration.
Figures and Tables -
Analysis 1.9

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 9 Pulp canal obliteration.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 10 Dentin bridge formation.
Figures and Tables -
Analysis 1.10

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 10 Dentin bridge formation.

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 11 Physiological root resorption.
Figures and Tables -
Analysis 1.11

Comparison 1 Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy, Outcome 11 Physiological root resorption.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 2.1

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 2.2

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 2 Radiological failure.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 3 Pain.
Figures and Tables -
Analysis 2.3

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 3 Pain.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 4 Soft tissue pathology.
Figures and Tables -
Analysis 2.4

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 5 Pathological radiolucency.
Figures and Tables -
Analysis 2.5

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 5 Pathological radiolucency.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 6 Pathological root resorption.
Figures and Tables -
Analysis 2.6

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 6 Pathological root resorption.

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 7 Pulp canal obliteration.
Figures and Tables -
Analysis 2.7

Comparison 2 Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy, Outcome 7 Pulp canal obliteration.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 3.1

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 3.2

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 2 Radiological failure.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 3 Pain.
Figures and Tables -
Analysis 3.3

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 3 Pain.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 4 Soft tissue pathology.
Figures and Tables -
Analysis 3.4

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 5 Pathological mobility.
Figures and Tables -
Analysis 3.5

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 5 Pathological mobility.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 6 Pathological radiolucency.
Figures and Tables -
Analysis 3.6

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 6 Pathological radiolucency.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 7 Pathological root resorption.
Figures and Tables -
Analysis 3.7

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 7 Pathological root resorption.

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 8 Pulp canal obliteration.
Figures and Tables -
Analysis 3.8

Comparison 3 Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 8 Pulp canal obliteration.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 4.1

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 1 Clinical failure.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 4.2

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 2 Radiological failure.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 3 Overall failure.
Figures and Tables -
Analysis 4.3

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 3 Overall failure.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 4 Pain.
Figures and Tables -
Analysis 4.4

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 4 Pain.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 5 Soft tissue pathology.
Figures and Tables -
Analysis 4.5

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 5 Soft tissue pathology.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 6 Pathologic mobility.
Figures and Tables -
Analysis 4.6

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 6 Pathologic mobility.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 7 Pathologic radiolucency.
Figures and Tables -
Analysis 4.7

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 7 Pathologic radiolucency.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 8 Pathological root resorption.
Figures and Tables -
Analysis 4.8

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 8 Pathological root resorption.

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 9 Pulp canal obliteration.
Figures and Tables -
Analysis 4.9

Comparison 4 Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy, Outcome 9 Pulp canal obliteration.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 5.1

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 1 Clinical failure.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 5.2

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 2 Radiological failure.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 3 Overall failure.
Figures and Tables -
Analysis 5.3

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 3 Overall failure.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 4 Pain.
Figures and Tables -
Analysis 5.4

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 4 Pain.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 5 Soft tissue pathology.
Figures and Tables -
Analysis 5.5

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 5 Soft tissue pathology.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 6 Pathological mobility.
Figures and Tables -
Analysis 5.6

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 6 Pathological mobility.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 7 Pathological radiolucency.
Figures and Tables -
Analysis 5.7

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 7 Pathological radiolucency.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 8 Pathological root resorption.
Figures and Tables -
Analysis 5.8

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 8 Pathological root resorption.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 9 Pulp canal obliteration.
Figures and Tables -
Analysis 5.9

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 9 Pulp canal obliteration.

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 10 Dentin bridge formation.
Figures and Tables -
Analysis 5.10

Comparison 5 Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy, Outcome 10 Dentin bridge formation.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 6.1

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 1 Clinical failure.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 6.2

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 2 Radiological failure.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 3 Pain.
Figures and Tables -
Analysis 6.3

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 3 Pain.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 4 Soft tissue pathology.
Figures and Tables -
Analysis 6.4

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 5 Pathologic mobility.
Figures and Tables -
Analysis 6.5

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 5 Pathologic mobility.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 6 Pathological radiolucency.
Figures and Tables -
Analysis 6.6

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 6 Pathological radiolucency.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 7 Pathological root resorption.
Figures and Tables -
Analysis 6.7

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 7 Pathological root resorption.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 8 Pulp canal obliteration.
Figures and Tables -
Analysis 6.8

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 8 Pulp canal obliteration.

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 9 Dentin bridge formation.
Figures and Tables -
Analysis 6.9

Comparison 6 Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy, Outcome 9 Dentin bridge formation.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 7.1

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 1 Clinical failure.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 7.2

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 2 Radiological failure.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 3 Pain.
Figures and Tables -
Analysis 7.3

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 3 Pain.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 4 Soft tissue pathology.
Figures and Tables -
Analysis 7.4

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 5 Pathologic mobility.
Figures and Tables -
Analysis 7.5

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 5 Pathologic mobility.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 6 Pathological radiolucency.
Figures and Tables -
Analysis 7.6

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 6 Pathological radiolucency.

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 7 Pathological root resorption.
Figures and Tables -
Analysis 7.7

Comparison 7 Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy, Outcome 7 Pathological root resorption.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 8.1

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 8.2

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 2 Radiological failure.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 3 Overall failure.
Figures and Tables -
Analysis 8.3

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 3 Overall failure.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 4 Pain.
Figures and Tables -
Analysis 8.4

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 4 Pain.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 5 Soft tissue pathology.
Figures and Tables -
Analysis 8.5

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 5 Soft tissue pathology.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 6 Pathological mobility.
Figures and Tables -
Analysis 8.6

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 6 Pathological mobility.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 7 Pathological radiolucency.
Figures and Tables -
Analysis 8.7

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 7 Pathological radiolucency.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 8 Pathological root resorption.
Figures and Tables -
Analysis 8.8

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 8 Pathological root resorption.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 9 Pulp canal obliteration.
Figures and Tables -
Analysis 8.9

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 9 Pulp canal obliteration.

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 10 Dentin bridge formation.
Figures and Tables -
Analysis 8.10

Comparison 8 Calcium hydroxide pulpotomy versus formocresol pulpotomy, Outcome 10 Dentin bridge formation.

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 9.1

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 1 Clinical failure.

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 9.2

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 2 Radiological failure.

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 3 Overall failure.
Figures and Tables -
Analysis 9.3

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 3 Overall failure.

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 4 Pathological root resorption.
Figures and Tables -
Analysis 9.4

Comparison 9 Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy, Outcome 4 Pathological root resorption.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 10.1

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 10.2

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 2 Radiological failure.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 3 Overall failure.
Figures and Tables -
Analysis 10.3

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 3 Overall failure.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 4 Pain.
Figures and Tables -
Analysis 10.4

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 4 Pain.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 5 Pathological radiolucency.
Figures and Tables -
Analysis 10.5

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 5 Pathological radiolucency.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 6 Pathological root resorption.
Figures and Tables -
Analysis 10.6

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 6 Pathological root resorption.

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 7 Pulp canal obliteration.
Figures and Tables -
Analysis 10.7

Comparison 10 Ferric sulphate pulpotomy versus formocresol pulpotomy, Outcome 7 Pulp canal obliteration.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 11.1

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 1 Clinical failure.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 11.2

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 2 Radiological failure.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 3 Pain.
Figures and Tables -
Analysis 11.3

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 3 Pain.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 4 Soft tissue pathology.
Figures and Tables -
Analysis 11.4

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 5 Adjacent tissue inflammation.
Figures and Tables -
Analysis 11.5

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 5 Adjacent tissue inflammation.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 6 Pathologic mobility.
Figures and Tables -
Analysis 11.6

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 6 Pathologic mobility.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 7 Pathologic radiolucency.
Figures and Tables -
Analysis 11.7

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 7 Pathologic radiolucency.

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 8 Pathologic root resorption.
Figures and Tables -
Analysis 11.8

Comparison 11 Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 8 Pathologic root resorption.

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 12.1

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 1 Clinical failure.

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 12.2

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 2 Radiological failure.

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 3 Pain.
Figures and Tables -
Analysis 12.3

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 3 Pain.

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 4 Pathological radiolucency.
Figures and Tables -
Analysis 12.4

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 4 Pathological radiolucency.

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 5 Pathological root resorption.
Figures and Tables -
Analysis 12.5

Comparison 12 Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 5 Pathological root resorption.

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 13.1

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 1 Clinical failure.

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 13.2

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 2 Radiological failure.

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 3 Pain.
Figures and Tables -
Analysis 13.3

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 3 Pain.

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 4 Pathological mobility.
Figures and Tables -
Analysis 13.4

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 4 Pathological mobility.

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 5 Pathological root resorption.
Figures and Tables -
Analysis 13.5

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 5 Pathological root resorption.

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 6 Pulp canal obliteration.
Figures and Tables -
Analysis 13.6

Comparison 13 Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy, Outcome 6 Pulp canal obliteration.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 14.1

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 1 Clinical failure.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 14.2

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 2 Radiological failure.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 3 Pain.
Figures and Tables -
Analysis 14.3

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 3 Pain.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 4 Soft tissue pathology.
Figures and Tables -
Analysis 14.4

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 5 Pathologic mobility.
Figures and Tables -
Analysis 14.5

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 5 Pathologic mobility.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 6 Pathologic radiolucency.
Figures and Tables -
Analysis 14.6

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 6 Pathologic radiolucency.

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 7 Pathologic root resorption.
Figures and Tables -
Analysis 14.7

Comparison 14 Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy, Outcome 7 Pathologic root resorption.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 15.1

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 1 Clinical failure.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 15.2

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 2 Radiological failure.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 3 Pain.
Figures and Tables -
Analysis 15.3

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 3 Pain.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 4 Pathological mobility.
Figures and Tables -
Analysis 15.4

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 4 Pathological mobility.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 5 Pathological radiolucency.
Figures and Tables -
Analysis 15.5

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 5 Pathological radiolucency.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 6 Pathological root resorption.
Figures and Tables -
Analysis 15.6

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 6 Pathological root resorption.

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 7 Pulp canal obliteration.
Figures and Tables -
Analysis 15.7

Comparison 15 Diode laser pulpotomy versus electrosurgery pulpotomy, Outcome 7 Pulp canal obliteration.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 16.1

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 16.2

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 2 Radiological failure.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 3 Pain.
Figures and Tables -
Analysis 16.3

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 3 Pain.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 4 Soft tissue pathology.
Figures and Tables -
Analysis 16.4

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 4 Soft tissue pathology.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 5 Pathologic mobility.
Figures and Tables -
Analysis 16.5

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 5 Pathologic mobility.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 6 Pathologic radiolucency.
Figures and Tables -
Analysis 16.6

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 6 Pathologic radiolucency.

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 7 Pathologic root resorption.
Figures and Tables -
Analysis 16.7

Comparison 16 Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy, Outcome 7 Pathologic root resorption.

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 17.1

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 1 Clinical failure.

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 2 Pain.
Figures and Tables -
Analysis 17.2

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 2 Pain.

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 3 Soft tissue pathology.
Figures and Tables -
Analysis 17.3

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 3 Soft tissue pathology.

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 4 Pathologic mobility.
Figures and Tables -
Analysis 17.4

Comparison 17 Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy, Outcome 4 Pathologic mobility.

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 1 Radiological failure.
Figures and Tables -
Analysis 18.1

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 1 Radiological failure.

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 2 Pain.
Figures and Tables -
Analysis 18.2

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 2 Pain.

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 3 Pathological mobility.
Figures and Tables -
Analysis 18.3

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 3 Pathological mobility.

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 4 Pathological radiolucency.
Figures and Tables -
Analysis 18.4

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 4 Pathological radiolucency.

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 5 Pathological radiolucency.
Figures and Tables -
Analysis 18.5

Comparison 18 Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 5 Pathological radiolucency.

Comparison 19 Metapex versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 19.1

Comparison 19 Metapex versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 1 Clinical failure.

Comparison 19 Metapex versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 19.2

Comparison 19 Metapex versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 2 Radiological failure.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 1 Clincal failure.
Figures and Tables -
Analysis 20.1

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 1 Clincal failure.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 20.2

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 2 Radiological failure.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 3 Pain.
Figures and Tables -
Analysis 20.3

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 3 Pain.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 4 Soft tissue pathology.
Figures and Tables -
Analysis 20.4

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 4 Soft tissue pathology.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 5 Pathologic mobility.
Figures and Tables -
Analysis 20.5

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 5 Pathologic mobility.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 6 Pathological radiolucency.
Figures and Tables -
Analysis 20.6

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 6 Pathological radiolucency.

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 7 Pathological root resorption.
Figures and Tables -
Analysis 20.7

Comparison 20 Metapex pulpectomy versus Endoflas pulpectomy, Outcome 7 Pathological root resorption.

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 21.1

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 1 Clinical failure.

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 21.2

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 2 Radiological failure.

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 3 Overall failure.
Figures and Tables -
Analysis 21.3

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 3 Overall failure.

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 4 Pain.
Figures and Tables -
Analysis 21.4

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 4 Pain.

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 5 Pathological mobility.
Figures and Tables -
Analysis 21.5

Comparison 21 Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy, Outcome 5 Pathological mobility.

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 1 Clinical failure.
Figures and Tables -
Analysis 22.1

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 1 Clinical failure.

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 2 Radiological failure.
Figures and Tables -
Analysis 22.2

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 2 Radiological failure.

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 3 Pain.
Figures and Tables -
Analysis 22.3

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 3 Pain.

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 4 Pathologic mobility.
Figures and Tables -
Analysis 22.4

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 4 Pathologic mobility.

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 5 Pathologic radiolucency.
Figures and Tables -
Analysis 22.5

Comparison 22 Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy, Outcome 5 Pathologic radiolucency.

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

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.

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

Figures and Tables -
Summary of findings for the main comparison. Pulpotomy compared with pulpotomy using alternative medicament/technique for extensive decay in primary teeth
Summary of findings 2. Pulpectomy compared with pulpectomy using alternative medicament for extensive decay in primary teeth

Pulpectomy compared with pulpectomy using alternative medicament for extensive decay in primary teeth

Population: children with extensive decay in primary teeth

Settings: primary care

Intervention: pulpectomy with 1 type of medicament

Comparison: pulpectomy using alternative medicament

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

Endoflas versus ZOE

Clinical failure (6 months)

128 per 1000

33.3 per 1000 (6.4 per 1000 to 192 per 1000)

RR 0.26 (0.05 to 1.50)

80 (2 studies)

⊕⊕⊕⊝
moderate1

One trial assessed failure at 12 months: RR 1.00, 95% 0.07 to 14.55

Radiological failure (6 months)

128 per 1000

33.3 per 1000 (6.4 per 1000 to 192 per 1000)

RR 0.26 (0.05 to 1.50)

80 (2 studies)

⊕⊕⊕⊝
moderate1

Metapex versus ZOE

Clinical failure (12 months)

97 per 1000

68.9 per 1000 (14.6 per 1000 to 323 per 1000)

RR 0.71 (0.15 to 3.33)

62 (2 studies)

⊕⊕⊕⊝
moderate1

Results similar at 6 months

Radiological failure (12 months)

129 per 1000

129 per 1000 (40 per 1000 to 421.8 per 1000)

RR 1.00 (0.31 to 3.27)

62 (2 studies)

⊕⊕⊕⊝
moderate1

Results similar at 6 months

Other comparisons assessed in more than one trial that had treatment failures

Clinical failure

The quality of the evidence was rated as low for 1 comparison: Vitapex versus ZOE (favouring ZOE)2

Radiological failure

The quality of the evidence was rated as low for 2 comparisons: Vitapex versus ZOE2 (favouring ZOE); calcium hydroxide versus ZOE3

1. Downgraded 1 level due to imprecision
2. Downgraded 2 levels due to very substantial inconsistency
3. Downgraded 1 level due to substantial inconsistency and 1 level due to imprecision

Figures and Tables -
Summary of findings 2. Pulpectomy compared with pulpectomy using alternative medicament for extensive decay in primary teeth
Summary of findings 3. Direct pulp capping compared with direct pulp capping using alternative medicament for extensive decay in primary teeth

Direct pulp capping compared with direct pulp capping using alternative medicament for extensive decay in primary teeth

Population: children with extensive decay in primary teeth

Settings: primary care

Intervention: direct pulp capping with 1 type of medicament

Comparison: direct pulp capping using alternative medicament

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

Seven trials evaluated 22 comparisons of different medicaments for direct pulp capping. Each comparison was assessed by a single trial.

There were no clinical or radiological failures in two comparisons: acetone‐based total‐etch adhesive versus calcium hydroxide; MTA versus calcium hydroxide.

Clinical failure (at six, 12 and 24 months)

The quality of the evidence was assessed as low for 5 comparisons1: calcium hydroxide versus formocresol (favouring formocrescol), MTA versus 3Mix and MTA versus simvastatin (favouring MTA), 3Mix versus 3Mixtatin and 3Mixtatin versus simvastatin (favouring 3Mixtatin).

The quality of the evidence was rated as very low for all other comparisons.2

Radiological failure (at six, 12 and 24 months)

The quality of the evidence was rated as low for 1 comparison: calcium hydroxide versus formocresol1 (favouring formocresol).

The quality of the evidence was rated as very low for all other comparisons.2

*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 risk of bias and 1 level due to imprecision
2. Downgraded 1 level due to risk of bias and 2 levels due to severe imprecision

Figures and Tables -
Summary of findings 3. Direct pulp capping compared with direct pulp capping using alternative medicament for extensive decay in primary teeth
Table 1. Pulpotomy (FS + MTA) versus pulpotomy (MTA)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Pain

mean 22

1

Not estimable*

Soft tissue pathology

mean 22

1

Not estimable*

Pathological mobility

mean 22

1

Not estimable*

Pathological radiolucency

mean 22

1

3.46 (0.17 to 70.69)

Pathological root resorption

mean 22

1

2.75 (0.82 to 9.29)

Pulp canal obliteration

mean 22

1

0.83 (0.51 to 1.33)

*due to lack of events

Abbreviations ‐ CI: confidence interval; FS: ferric sulphate; MTA: mineral trioxide aggregate

Figures and Tables -
Table 1. Pulpotomy (FS + MTA) versus pulpotomy (MTA)
Table 2. Pulpotomy (CEM cement) versus pulpotomy (MTA)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6, 12 and 18

1

Not estimable*

Radiological failure

6

1

Not estimable*

12

1

0.33 (0.04 to 2.94)

18

1

0.33 (0.04 to 2.94)

Pathological root resorption

6

1

Not estimable*

12

1

0.33 (0.04 to 2.94)

18

1

0.33 (0.04 to 2.94)

*due to lack of events

Abbreviations ‐ CEM: calcium‐enriched mixture; CI: confidence interval; MTA: mineral trioxide aggregate

Figures and Tables -
Table 2. Pulpotomy (CEM cement) versus pulpotomy (MTA)
Table 3. Pulpotomy (MTA) versus pulpotomy (NaOCl)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6 and 12

1

Not estimable*

24

1

0.33 (0.01, 7.81)

Radiological failure

6 and 12

1

0.14 (0.01, 2.63)

24

1

0.33 (0.04, 2.99)

Overall failure

24

1

0.33 (0.04, 2.99)

Pain

6, 12 and 24 months

1

Not estimable*

Soft tissue pathology

6 and 12

1

Not estimable*

24

1

0.33 (0.01, 7.81)

Pathologic mobility

6, 12 and 24 months

1

Not estimable*

Pathologic radiolucency

6, 12 and 24 months

1

Not estimable*

Pathologicroot resorption

6 and 12

1

0.14 (0.01, 2.63)

24

1

0.33 (0.04, 2.99)

*due to lack of events

Abbreviations ‐ CI: confidence interval; MTA: mineral trioxide aggregate; NaOCl: sodium hypochlorite

Figures and Tables -
Table 3. Pulpotomy (MTA) versus pulpotomy (NaOCl)
Table 4. Pulpotomy (MTA) versus pulpotomy (CH+NaOCl)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6 and 12

1

Not estimable*

Radiological failure

6

1

Not estimable*

12

1

0.09 (0.01, 1.58)

Soft tissue pathology

6 and 12

1

Not estimable*

Pathologic mobility

6 and 12

1

Not estimable*

Adjacent tissue inflammation

6 and 12

1

Not estimable*

Pathologic radiolucency

6

1

Not estimable*

12

1

0.14 (0.01, 2.66)

Pathologicroot resorption

6

1

Not estimable*

12

1

0.14 (0.01, 2.66)

Pulp canal obliteration

6

1

Not estimable*

12

1

0.44 (0.15, 1.29)

*due to lack of events

Abbreviations ‐ CI: confidence interval; MTA: mineral trioxide aggregate; CH: calcium hydroxyde; NaOCl; sodium hypochlorite

Figures and Tables -
Table 4. Pulpotomy (MTA) versus pulpotomy (CH+NaOCl)
Table 5. Pulpotomy (MTA + NaOCl) versus pulpotomy (CH + NaOCl)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6 and 12

1

Not estimable*

Radiological failure

6

1

Not estimable*

12

1

0.20 (0.02, 1.61)

Soft tissue pathology

6 and 12

1

Not estimable*

Pathologic mobility

6 and 12

1

Not estimable*

Adjacent tissue inflammation

6 and 12

1

Not estimable*

Pathologic radiolucency

6

1

Not estimable*

12

1

0.14 (0.01, 2.66)

Pathologic root resorption

6

1

Not estimable*

12

1

0.33 (0.04, 3.03)

Pulp canal obliteration

6

1

Not estimable*

12

1

0.67 (0.27, 1.65)

*due to lack of events

Abbreviations ‐ CI: confidence interval; MTA: mineral trioxide aggregate; NaOCl; sodium hypochlorite; CH: calcium hydroxyde.

Figures and Tables -
Table 5. Pulpotomy (MTA + NaOCl) versus pulpotomy (CH + NaOCl)
Table 6. Pulpotomy (MTA) versus pulpotomy (2% buffered glutaraldehyde)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Pain

6

1

0.06 (0.00, 0.98)

Soft tissue pathology

6

1

0.08 (0.00, 1.31)

Pathologic mobility

6

1

0.06 (0.00, 0.98)

Pathologic radiolucency

6

1

0.03 (0.00, 0.55)

Pathologic root resorption

6

1

0.05 (0.00, 0.78)

Pulp canal obliteration

6

1

0.11 (0.01, 1.98)

*due to lack of events

Abbreviations ‐ CI: confidence interval; MTA: mineral trioxide aggregate.

Figures and Tables -
Table 6. Pulpotomy (MTA) versus pulpotomy (2% buffered glutaraldehyde)
Table 7. Pulpotomy (MTA) versus pulpotomy (ZOE)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12

1

Not estimable*

24

1

0.20 (0.03 to 1.59)

Radiological failure

6

1

0.33 (0.01 to 7.81)

12

1

0.20 (0.01 to 3.97)

24

1

0.10 (0.01 to 0.72)

Overall failure

6

1

0.33 (0.01 to 7.81)

12

1

0.20 (0.01 to 3.97)

24

1

0.13 (0.02 to 0.93)

Pain

6

1

Not estimable*

12

1

Not estimable*

24

1

3.00 (0.13 to 70.30)

Pathological radiolucency

6

1

Not estimable*

12

1

Not estimable*

24

1

3.00 (0.13 to 70.30)

Pathological root resorption

6

1

0.33 (0.01 to 7.81)

12

1

0.33 (0.01 to 7.81)

24

1

0.08 (0.00 to 1.30)

Pulp canal obliteration

6

1

Not estimable*

12

1

3.00 (0.13 to 70.30)

24

1

11.0 (0.64 to 188.96)

Physiological root resorption

6

1

Not estimable*

12

1

Not estimable*

24

1

0.20 (0.01 to 3.97)

*due to lack of events

Abbreviations ‐ CI: confidence interval; MTA: mineral trioxide aggregate; ZOE: zinc oxide and eugenol

Figures and Tables -
Table 7. Pulpotomy (MTA) versus pulpotomy (ZOE)
Table 8. Pulpotomy (diode laser + MTA) versus pulpotomy (FC + ZOE)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

15.7

1

Not estimable*

Radiological failure

15.7

1

4.00 (0.48 to 33.42)

Overall failure

15.7

1

2.00 (0.40 to 9.99)

Pathological radiolucency

15.7

1

3.00 (0.33 to 26.99)

Pathological root resorption

15.7

1

1.50 (0.27 to 8.25)

*due to lack of events

Abbreviations ‐ CI: confidence interval; FC: formocresol; MTA: mineral trioxide aggregate; ZOE: zinc oxide and eugenol

Figures and Tables -
Table 8. Pulpotomy (diode laser + MTA) versus pulpotomy (FC + ZOE)
Table 9. Pulpotomy (MTA) versus pulpotomy (EMD)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6, 12 and 24

1

0.14 (0.01, 2.67)

Radiological failure

24

1

0.29 (0.06, 1.28)

Overall failure

6, 12 and 24

1

0.14 (0.01, 2.67)

Pain

6, 12 and 24

1

0.33 (0.01, 7.91)

Soft tissue pathology

6, 12 and 24

1

0.20 (0.01, 4.02)

Pathologic mobility

6, 12 and 24

1

0.20 (0.01, 4.02)

Pathologic radiolucency

24

1

0.40 (0.08, 1.93)

Pathologic root resorption

24

1

0.20 (0.01, 4.02)

Abbreviations ‐ CI: confidence interval; MTA: mineral trioxide aggregate; EMD: enamel matrix derivative

Figures and Tables -
Table 9. Pulpotomy (MTA) versus pulpotomy (EMD)
Table 10. Pulpotomy (Tempophore) versus pulpotomy (MTA)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6 and 12

1

3.21 (0.14, 75.68)

Radiological failure

6

1

9.64 (0.54, 171.09)

12

1

2.69 (0.57, 12.70)

Pathological radiolucency

6

1

3.21 (0.14, 75.68)

12

1

2.15 (0.43, 10.79)

Pathological root resorption

6

1

6.44 (0.83, 50.11)

12

1

4.30 (1.00, 18.47)

Pulp canal obliteration

6

1

3.76 (0.85, 16.54)

12

1

1.61 (0.78, 3.33)

Dentine bridge formation

6

1

0.15 (0.01, 2.83)

12

1

0.07 (0.00, 1.19)

Abbreviation: CI: confidence interval

Figures and Tables -
Table 10. Pulpotomy (Tempophore) versus pulpotomy (MTA)
Table 11. Pulpotomy (MTA) versus pulpotomy (MTA + NaOCl)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6 and 12

1

Not estimable*

Radiological failure

6 and 12

1

0.33 (0.01, 7.88)

Soft tissue pathology

6 and 12

1

Not estimable*

Pathologic mobility

6 and 12

1

Not estimable*

Adjacent tissue inflammation

6 and 12

1

Not estimable*

Pathologic radiolucency

6 and 12

1

Not estimable*

Pathologic root resorption

6 and 12

1

0.33 (0.01, 7.88)

Pulp canal obliteration

6

1

Not estimable*

12

1

0.67 (0.21, 2.13)

* due to lack of events

Abbreviations ‐ CI: confidence interval; MTA: mineral trioxide aggregate; NaOCl; sodium hypochlorite.

Figures and Tables -
Table 11. Pulpotomy (MTA) versus pulpotomy (MTA + NaOCl)
Table 12. Pulpotomy (ProRoot MTA) versus pulpotomy (OrthoMTA)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12

1

0.33 (0.01, 7.98)

Radiological failure

6

1

1.00 (0.06, 15.52)

12

1

0.50 (0.05, 5.33)

Pain

6 and 12

1

Not estimable*

Soft tissue pathology

6

1

Not estimable*

12

1

0.33 (0.01, 7.98)

Pathologic mobility

6 and 12

1

Not estimable*

Pathologic radiolucency

6

1

0.33 (0.01, 7.98)

12

1

0.20 (0.01, 4.06)

Pathologic root resorption

6

1

3.00 (0.13, 71.82)

12

1

1.00 (0.06, 15.52)

*due to lack of events

Abbreviation: CI: confidence interval.

Figures and Tables -
Table 12. Pulpotomy (ProRoot MTA) versus pulpotomy (OrthoMTA)
Table 13. Pulpotomy (ProRoot MTA) versus pulpotomy (RetroMTA)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6 and 12

1

Not estimable*

Radiological failure

6 and 12

1

0.35 (0.04, 3.22)

Pain

6 and 12

1

Not estimable*

Soft tissue pathology

6 and 12

1

Not estimable*

Pathologic mobility

6 and 12

1

Not estimable*

Pathologic radiolucency

6 and 12

1

0.35 (0.01, 8.32)

Pathologic root resorption

6 and 12

1

0.35 (0.04, 3.22)

*due to lack of events

Abbreviation: CI: confidence interval.

Figures and Tables -
Table 13. Pulpotomy (ProRoot MTA) versus pulpotomy (RetroMTA)
Table 14. Pulpotomy (OrthoMTA) versus pulpotomy (RetroMTA)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12

1

3.13 (0.13, 74.85)

Radiological failure

6

1

0.35 (0.04, 3.22)

12

1

0.70 (0.12, 3.98)

Pain

6 and 12

1

Not estimable*

Soft tissue pathology

6

1

Not estimable*

12

1

3.13 (0.13, 74.85)

Pathologic mobility

6 and 12

1

Not estimable*

Pathologic radiolucency

6

1

1.04 (0.07, 16.19)

12

1

2.09 (0.20, 22.24)

Pathologic root resorption

6

1

0.15 (0.01, 2.81)

12

1

0.35 (0.04, 3.22)

*due to lack of events

Abbreviation: CI: confidence interval.

Figures and Tables -
Table 14. Pulpotomy (OrthoMTA) versus pulpotomy (RetroMTA)
Table 15. Pulpotomy (CH) versus pulpotomy (PC)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

5.00 (0.26, 96.13)

12 and 24

1

13.00 (0.80, 212.02)

Radiological failure

6

1

13.00 (0.80, 212.02)

12

1

17.00 (1.07 to 270.41)

24

1

21.00 (1.34 to 328.86)

Soft tissue pathology

6

1

5.00 (0.26, 96.13)

12 and 24

1

13.00 (0.80, 212.02)

Pathologic mobility

6

1

5.00 (0.26, 96.13)

12 and 24

1

13.00 (0.80, 212.02)

Adjacent tissue inflammation

6, 12 and 24

1

Not estimable *

Pathologic radiolucency

6

1

13.00 (0.80, 212.02)

12

1

17.00 (1.07 to 270.41)

24

1

21.00 (1.34 to 328.86)

Pathologic root resorption

6

1

13.00 (0.80, 212.02)

12

1

17.00 (1.07 to 270.41)

24

1

21.00 (1.34 to 328.86)

Dentine bridge formation

6, 12 and 24

1

0.50 (0.11 to 2.33)

*due to lack of events

Abbreviations ‐ CI: confidence interval; CH: calcium hydroxide; PC: Portland cement.

Figures and Tables -
Table 15. Pulpotomy (CH) versus pulpotomy (PC)
Table 16. Pulpotomy (CH) versus pulpotomy (MTA + NaOCl)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12

1

3.00 (0.13, 70.92)

Radiological failure

6

1

5.00 (0.62, 40.36)

12

1

8.00 (1.06, 60.21)

Soft tissue pathology

6

1

Not estimable*

12

1

3.00 (0.13, 70.92)

Pathologic mobility

6 and 12

1

Not estimable*

Adjacent tissue inflammation

6 and 12

1

Not estimable*

Pathologic radiolucency

6

1

Not estimable*

12

1

15.00 (0.89, 251.77)

Pathologic root resorption

6

1

Not estimable*

12

17.00 (1.02, 282.30)

Pulp canal obliteration

6

1

Not estimable*

12

1

1.33 (0.52, 3.39)

*due to lack of events

Abbreviations ‐ CI: confidence interval; CH: calcium hydroxyde; MTA: mineral trioxide aggregate; NaOCl; sodium hypochlorite.

Figures and Tables -
Table 16. Pulpotomy (CH) versus pulpotomy (MTA + NaOCl)
Table 17. Pulpotomy (Er:YAG laser) versus pulpotomy (CH)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

0.31 (0.01 to 7.48)

12

1

0.94 (0.60 to 14.52)

24

1

0.62 (0.11 to 3.56)

Radiological failure

12

1

0.56 (0.14 to 2.21)

24

1

0.31 (0.11 to 0.90)

Overall failure

12

1

0.56 (0.14 to 2.21)

24

1

0.31 (0.11 to 0.90)

Pain

6, 12 and 24

1

Not estimable*

Soft tissue pathology

6, 12 and 24

1

Not estimable*

Pathological mobility

6, 12 and 24

1

Not estimable*

Pathological radiolucency

12

1

0.31 (0.01 to 7.48)

24

1

0.62 (0.11 to 3.56)

Pathological root resorption

12

1

0.94 (0.60 to 14.52)

24

1

0.62 (0.11 to 3.56)

*due to lack of events

Abbreviations ‐ CI: confidence interval; Er:YAG: erbium:yttrium‐aluminium garnet; CH: calcium hydroxide.

Figures and Tables -
Table 17. Pulpotomy (Er:YAG laser) versus pulpotomy (CH)
Table 18. Pulpotomy (CH/iodoform) versus pulpotomy (CH)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

1.41 (0.77 to 2.58)

12

1

1.13 (0.82 to 1.54)

Radiological failure

6

1

1.33 (0.89 to 2.00)

12

1

1.17 (0.87 to 1.59)

Pain

6

1

1.72 (0.45 to 6.61)

12

1

1.03 (0.33 to 3.23)

Soft tissue pathology

6

1

1.55 (0.28 to 8.65)

12

1

1.03 (0.22 to 4.74)

Pathological radiolucency

6 and 12

1

5.15 (0.26 to 103.31)

Pathological root resorption

6

1

1.72 (0.45 to 6.61)

12

1

1.29 (0.38 to 4.37)

CI: confidence interval; CH: calcium hydroxide.

Figures and Tables -
Table 18. Pulpotomy (CH/iodoform) versus pulpotomy (CH)
Table 19. Pulpotomy (CH + NaOCl) versus pulpotomy (CH)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12

1

0.33 (0.01, 7.88)

Radiological failure

6

1

0.09 (0.01, 1.58)

12

1

0.63 (0.23, 1.70)

Soft tissue pathology

6

1

Not estimable*

12

1

0.33 (0.01, 7.88)

Pathologic mobility

6 and 12

1

Not estimable*

Adjacent tissue inflammation

6 and 12

1

Not estimable*

Pathologic radiolucency

6

1

Not estimable*

12

1

0.43 (0.12, 1.51)

Pathologic root resorption

6

1

Not estimable*

12

0.38 (0.11, 1.28)

Pulp canal obliteration

6

1

Not estimable*

12

1

1.13 (0.50, 2.53)

*due to lack of events

Abbreviations ‐ CI: confidence interval; CH: calcium hydroxide; NaOCl: sodium hypochlorite.

Figures and Tables -
Table 19. Pulpotomy (CH + NaOCl) versus pulpotomy (CH)
Table 20. Pulpotomy (FS) versus pulpotomy (buffered glutaraldehyde)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Pain

6

1

0.25 (0.06, 1.08)

Soft tissue pathology

6

1

0.33 (0.07, 1.52)

Pathologic mobility

6

1

0.75 (0.30, 1.90)

Pathologic radiolucency

6

1

1.14 (0.69, 1.90)

Pathologic root resorption

6

1

1.20 (0.61, 2.34)

Pulp canal obliteration

6

1

0.11 (0.01, 1.98)

*due to lack of events

Abbreviations ‐ CI: confidence interval; FS: ferric sulfate.

Figures and Tables -
Table 20. Pulpotomy (FS) versus pulpotomy (buffered glutaraldehyde)
Table 21. Pulpotomy (FS) versus pulpotomy (ZOE)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6 and 12

1

Not estimable*

24

1

1.20 (0.42 to 3.43)

Radiological failure

6

1

0.33 (0.01 to 7.81)

12

1

0.20 (0.01 to 3.97)

24

1

0.60 (0.26 to 1.40)

Overall failure

6

1

0.33 (0.01 to 7.81)

12

1

0.20 (0.01 to 3.97)

24

1

0.38 (0.11 to 1.25)

Pain

6, 12 and 24

1

Not estimable*

Pathological radiolucency

6, 12 and 24

1

Not estimable*

Pathological root resorption

6

1

0.33 (0.01 to 7.81)

12

1

0.33 (0.01 to 7.81)

24

1

0.17 (0.02 to 1.29)

Physiological root resorption

6 and 12

1

Not estimable*

24

1

1.50 (0.27 to 8.22)

Pulp canal obliteration

6, 12 and 24

1

Not estimable*

*due to lack of events

Abbreviations ‐ CI: confidence interval; FS: ferric sulphate; ZOE: zinc oxide and eugenol

Figures and Tables -
Table 21. Pulpotomy (FS) versus pulpotomy (ZOE)
Table 22. Pulpotomy (Er:YAG laser) versus pulpotomy (FS)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12

1

3.19 (0.13 to 76.37)

24

1

5.31 (0.26 to 107.86)

Radiological failure

12

1

0.46 (0.13 to 1.66)

24

1

0.61 (0.19 to 1.94)

Overall failure

12

1

0.46 (0.13 to 1.66)

24

1

0.61 (0.19 to 1.94)

Pain

6, 12 and 24

1

Not estimable*

Soft tissue pathology

6, 12 and 24

1

Not estimable*

Pathological mobility

6, 12 and 24

1

Not estimable*

Pathological radiolucency

12

1

0.15 (0.01 to 2.86)

24

1

0.71 (0.12 to 4.06)

Pathological root resorption

12

1

0.53 (0.05 to 5.67)

24

1

1.06 (0.16 to 7.25)

*due to lack of events

Abbreviations ‐ CI: confidence interval; Er:YAG: erbium:yttrium‐aluminium garnet; FS: ferric sulphate

Figures and Tables -
Table 22. Pulpotomy (Er:YAG laser) versus pulpotomy (FS)
Table 23. Pulpotomy (FS + MTA) versus pulpotomy (FS)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Pain

mean 22

1

0.25 (0.01 to 6.08)

Soft tissue pathology

mean 22

1

0.25 (0.01 to 6.08)

Pathological mobility

mean 22

1

0.15 (0.01 to 3.09)

Adjacent tissue inflammation

mean 22

1

0.25 (0.01 to 6.08)

Pathological radiolucency

mean 22

1

0.29 (0.01 to 6.92)

Pathological root resorption

mean 22

1

0.60 (0.31 to 1.19)

Pulp canal obliteration

mean 22

1

1.39 (0.78 to 2.49)

CI: confidence interval; FS: ferric sulphate; MTA: mineral trioxide aggregate

Figures and Tables -
Table 23. Pulpotomy (FS + MTA) versus pulpotomy (FS)
Table 24. Pulpotomy (PC) versus pulpotomy (FC)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6, 12 and 24

1

2.00 (0.19, 21.06)

Radiological failure

24

1

0.80 (0.23, 2.73)

Overall failure

6, 12 and 24

1

2.00 (0.19, 21.06)

Pain

6, 12 and 24

1

1.00 (0.07, 15.36)

Soft tissue pathology

6, 12 and 24

1

2.00 (0.19, 21.06)

Pathologic mobility

6, 12 and 24

1

3.00 (0.13, 71.22)

Pathologic radiolucency

24

1

1.00 (0.22, 4.62)

Pathologic root resorption

24

1

0.50 (0.05, 5.27)

Abbreviations ‐ CI: confidence interval; PC: Portland cement; FC: formocresol

Figures and Tables -
Table 24. Pulpotomy (PC) versus pulpotomy (FC)
Table 25. Pulpotomy (PC) versus pulpotomy (EMD)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6, 12 and 24

1

0.67 (0.12, 3.75)

Radiological failure

24

1

0.57 (0.18, 1.78)

Overall failure

6, 12 and 24

1

0.67 (0.12, 3.75)

Pain

6, 12 and 24

1

1.00 (0.07, 15.36)

Soft tissue pathology

6, 12 and 24

1

1.00 (0.15, 6.71)

Pathologic mobility

6, 12 and 24

1

0.50 (0.05, 5.27)

Pathologic radiolucency

24

1

0.60 (0.16, 2.32)

Pathologic root resorption

24

1

0.50 (0.05, 5.27)

*due to lack of events

Abbreviations ‐ CI: confidence interval; PC: Portland cement; EMD: enamel matrix derivative

Figures and Tables -
Table 25. Pulpotomy (PC) versus pulpotomy (EMD)
Table 26. Pulpotomy (glutaraldehyde + CH) versus pulpotomy (glutaraldehyde + ZOE)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

12

1

2.90 (0.32 to 26.38)

Radiological failure

12

1

1.11 (0.46 to 2.67)

Pain

12

1

Not estimable*

Pathological radiolucency

12

1

0.97 (0.39 to 2.43)

Pathological root resorption

12

1

0.97 (0.15 to 6.44)

*due to lack of events

Abbreviations ‐ CH: calcium hydroxide; CI: confidence interval; ZOE: zinc oxide and eugenol

Figures and Tables -
Table 26. Pulpotomy (glutaraldehyde + CH) versus pulpotomy (glutaraldehyde + ZOE)
Table 27. Pulpotomy (electrofulguration + CH) versus pulpotomy (electrofulguration + ZOE)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

0.83 (0.26, 2.73)

Radiological failure

6

1

0.94 (0.47, 1.88)

Overall failure

6

1

0.94 (0.47, 1.88)

Pain

6

1

Not estimable*

Soft tissue pathology

6

1

0.83 (0.26, 2.73)

Pathologic mobility

6

1

Not estimable*

Pathologic radiolucency

6

1

1.04 (0.43, 2.51)

Pathologic root resorption

6

1

0.75 (0.28, 2.02)

Pulp canal obliteration

6

1

1.04 (0.16, 6.80)

*due to lack of events

Abbreviations ‐ CI: confidence interval; CH: calcium hydroxide; ZOE: zinc oxide eugenol

Figures and Tables -
Table 27. Pulpotomy (electrofulguration + CH) versus pulpotomy (electrofulguration + ZOE)
Table 28. Pulpotomy (electrosurgery) versus pulpotomy (FC)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

9

1

3.00 (0.13 to 71.22)

Radiological failure

9

1

5.00 (0.62 to 40.64)

Pain

6

1

Not estimable*

Soft tissue pathology

6

1

3.00 (0.13 to 71.22)

Pathological mobility

6

1

Not estimable*

Pathological radiolucency

6

1

5.00 (0.25 to 100.54)

Pathological root resorption

6

1

5.00 (0.25 to 100.54)

*due to lack of events

Abbreviations ‐ CI: confidence interval; FC: formocresol

Figures and Tables -
Table 28. Pulpotomy (electrosurgery) versus pulpotomy (FC)
Table 29. Pulpotomy (Biodentine) versus pulpotomy (Tempophore)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6 and 12

1

1.08 (0.07, 16.36)

Radiological failure

6 and 12

1

0.54 (0.11, 2.70)

Pathological radiolucency

6

1

2.16 (0.21, 22.38)

12

1

0.54 (0.11, 2.70)

Pathological root resorption

6

1

0.36 (0.08, 1.62)

12

1

0.31 (0.07, 1.35)

Pulp canal obliteration

6

1

1.39 (0.61, 3.17)

12

1

1.08 (0.60, 1.94)

Dentine bridge formation

6

1

Not estimable*

12

1

11.85 (0.69, 203.86)

*due to lack of events

Abbreviations ‐ CI: confidence interval

Figures and Tables -
Table 29. Pulpotomy (Biodentine) versus pulpotomy (Tempophore)
Table 30. Pulpotomy (CH/iodoform) versus pulpotomy (FC)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

16.41 (2.30 to 117.26)

12

1

9.11 (3.04 to 27.31)

Radiological failure

6

1

24.06 (3.44 to 168.43)

12

1

9.11 (3.04 to 27.31)

Pain

6

1

5.47 (0.67 to 44.34)

12

1

5.47 (0.67 to 44.34)

Soft tissue pathology

6

1

7.64 (0.41 to 142.35)

12

1

7.64 (0.41 to 142.35)

Pathological radiolucency

6

1

2.19 (0.21 to 22.99)

12

1

2.19 (0.21 to 22.99)

Pathological root resorption

6

1

12.00 (0.69 to 208.77)

12

1

5.47 (0.67 to 44.34)

Abbreviations ‐ CH: calcium hydroxide; CI: confidence interval; FC: formocresol

Figures and Tables -
Table 30. Pulpotomy (CH/iodoform) versus pulpotomy (FC)
Table 31. Pulpotomy (ZOE) versus pulpotomy (FC)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12

1

Not estimable*

24

1

0.83 (0.29 to 2.38)

Radiological failure

6

1

3.00 (0.13 to 70.30)

12

1

5.00 (0.25 to 99.17)

24

1

1.67 (0.71 to 3.89)

Overall failure

6

1

3.00 (0.13 to 70.30)

12

1

5.00 (0.25 to 99.17)

24

1

2.67 (0.80 to 8.90)

Pain

6, 12 and 24

1

Not estimable*

Pathological radiolucency

6, 12 and 24

1

Not estimable*

Pathological root resorption

6

1

3.00 (0.13 to 70.30)

12

1

3.00 (0.13 to 70.30)

24

1

6.00 (0.78 to 46.29)

Pulp canal obliteration

6

1

Not estimable*

12

1

0.20 (0.01 to 3.97)

24

1

0.20 (0.01 to 3.97)

Physiological root resorption

6

1

Not estimable*

12

1

Not estimable*

24

1

2.00 (0.19 to 20.67)

*due to lack of events

Abbreviations ‐ CI: confidence interval; FC: formocresol; ZOE: zinc oxide and eugenol

Figures and Tables -
Table 31. Pulpotomy (ZOE) versus pulpotomy (FC)
Table 32. Pulpotomy (Er:YAG laser) versus pulpotomy (FC)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12

1

3.19 (0.13 to 76.37)

24

1

2.13 (0.20 to 22.70)

Radiological failure

6

1

Not estimable*

12

1

1.60 (0.28 to 9.13)

24

1

1.06 (0.28 to 4.01)

Overall failure

6

1

Not estimable*

12

1

1.60 (0.28 to 9.13)

24

1

1.06 (0.28 to 4.01)

Pain

6, 12 and 24

1

Not estimable*

Soft tissue pathology

6

1

Not estimable*

12

1

Not estimable*

24

1

0.35 (0.01 to 8.49)

Pathological mobility

6, 12 and 24

1

Not estimable*

Pathological radiolucency

6

1

Not estimable*

12

1

0.21 (0.01 to 4.31)

24

1

1.06 (0.16 to 7.25)

Pathological root resorption

6

1

Not estimable*

12

1

3.19 (0.13 to 76.37)

24

1

1.06 (0.16 to 7.25)

*due to lack of events

Abbreviations ‐ CI: confidence interval; Er:YAG: erbium:yttrium‐aluminium garnet; FC: formocresol

Figures and Tables -
Table 32. Pulpotomy (Er:YAG laser) versus pulpotomy (FC)
Table 33. Pulpotomy (diode laser) versus pulpotomy (FC)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12

1

0.33 (0.01, 7.95)

Radiological failure

6

1

1.67 (0.43, 6.51)

12

1

2.00 (0.75, 5.33)

*due to lack of events

Abbreviations ‐ CI: confidence interval; FC: formocresol.

Figures and Tables -
Table 33. Pulpotomy (diode laser) versus pulpotomy (FC)
Table 34. Pulpotomy (ABS) versus pulpotomy (FC)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6 and 12

1

0.33 (0.01, 7.58)

24

1

1.00 (0.16, 6.20)

Radiological failure

6 and 12

1

1.00 (0.16, 6.20)

24

1

0.67 (0.13, 3.44)

Pain

6 and 12

1

0.33 (0.01, 7.58)

24

1

1.00 (0.16, 6.20)

Soft tissue pathology

6, 12 and 24 months

1

0.33 (0.01, 7.58)

Pathologic mobility

6, 12 and 24 months

1

0.33 (0.01, 7.58)

Pathological radiolucency

6 and 12

1

Not estimable*

Pathological root resorption

6 and 12

1

1.00 (0.16, 6.20)

24

1

0.67 (0.13, 3.44)

*due to lack of events

Abbreviation ‐ CI: confidence interval

Figures and Tables -
Table 34. Pulpotomy (ABS) versus pulpotomy (FC)
Table 35. Pulpectomy (Sealapex) versus pulpectomy (CH)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

1.00 (0.07 to 14.90)

12

1

0.50 (0.10 to 2.43)

Radiological failure

6 and 12

1

0.50 (0.10 to 2.43)

Pain

6 and 12

1

1.00 (0.07 to 14.90)

Pathological mobility

6 and 12

1

1.00 (0.07 to 14.90)

Pathological radiolucency

6 and 12

1

0.20 (0.01 to 3.92)

Pathological root resorption

6 and 12

1

5.00 (0.26 to 98.00)

Filling material anomaly

6 and 12

1

Not estimable*

*due to lack of events

Abbreviations ‐ CI: confidence interval; Sealapex: eugenol‐free CH; CH: calcium hydroxide.

Figures and Tables -
Table 35. Pulpectomy (Sealapex) versus pulpectomy (CH)
Table 36. Pulpectomy (Vitapex) versus pulpectomy (CH)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

0.33 (0.01 to 7.72)

12

1

0.11 (0.01 to 1.94)

Radiological failure

6 and 12

1

0.11 (0.01 to 1.94)

Pain

6 and 12

1

0.33 (0.01 to 7.72)

Pathological mobility

6 and 12

1

0.33 (0.01 to 7.72)

Pathological radiolucency

6 and 12

1

0.20 (0.01 to 3.92)

Pathological root resorption

6 and 12

1

Not estimable*

Filling material anomaly

6 and 12

1

3.00 (0.13 to 69.52)

*due to lack of events

Abbreviations ‐ CI: confidence interval; Vitapex: CH/iodoform; CH: calcium hydroxide.

Figures and Tables -
Table 36. Pulpectomy (Vitapex) versus pulpectomy (CH)
Table 37. Pulpectomy (Vitapex) versus pulpectomy (Sealapex)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

0.33 (0.01 to 7.72)

12

1

0.20 (0.01 to 3.92)

Radiological failure

6 and 12

1

0.20 (0.01 to 3.92)

Pain

6 and 12

1

0.33 (0.01 to 7.72)

Pathological mobility

6 and 12

1

0.33 (0.01 to 7.72)

Pathological radiolucency

6 and 12

1

Not estimable*

Pathological root resorption

6 and 12

1

0.20 (0.01 to 3.92)

Filling material anomaly

6 and 12

1

3.00 (0.13 to 69.52)

*due to lack of events

Abbreviations ‐ CI: confidence interval; Vitapex: CH/iodoform; CH: calcium hydroxide; Sealapex: eugenol‐free CH.

Figures and Tables -
Table 37. Pulpectomy (Vitapex) versus pulpectomy (Sealapex)
Table 38. Pulpectomy (Vitapex) versus pulpectomy (3Mix)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12

1

1.0 (0.07 to 15.12)

Radiological failure

6

1

1.25 (0.38 to 4.12)

12

1

1.83 (0.80 to 4.19)

Pain

6

1

Not estimable*

12

1

3.00 (0.13 to 70.30)

Soft tissue pathology

6

1

Not estimable*

12

1

1.0 (0.07 to 15.12)

Pathological mobility

6 and 12

1

Not estimable*

Pathological radiolucency

6

1

1.50 (0.27 to 8.22)

12

1

2.75 (1.01 to 7.48)

Pathological root resorption

6 and 12

1

0.20 (0.01 to 3.97)

Pulp canal obliteration

6

1

Not estimable*

12

1

0.20 (0.01 to 3.97)

*due to lack of events

Abbreviations ‐ CI: confidence interval; Vitapex: CH/iodoform; CH: calcium hydroxide; 3Mix: ciprofloxacin + metronidazole + minocycline.

Figures and Tables -
Table 38. Pulpectomy (Vitapex) versus pulpectomy (3Mix)
Table 39. Pulpectomy (Vitapex) versus pulpectomy (MPRCF)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12

1

21.79 (1.32, 360.78)

Radiological failure

6

1

6.63 (0.35, 125.41)

12

1

42.63 (2.65, 685.54)

*due to lack of events

Abbreviations ‐ CI: confidence interval; Vitapex: CH/iodoform; MPRCF: ZOE (zinc oxide eugenol), calcium hydroxide, iodoform.

Figures and Tables -
Table 39. Pulpectomy (Vitapex) versus pulpectomy (MPRCF)
Table 40. Pulpotomy (FS) versus pulpectomy (Sedanol)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Pain

24

1

1.80 (0.07 to 43.88)

Soft tissue pathology

24

1

4.21 (0.22 to 80.70)

Pathological radiolucency

24

1

0.60 (0.25 to 1.46)

Pathological root resorption

24

1

21.04 (1.28 to 346.39)

Pulp canal obliteration

24

1

27.05 (1.66 to 441.49)

Abbreviations ‐ CI: confidence interval; FS: ferric sulphate; Sedanol=ZOE: zinc oxide and eugenol.

Figures and Tables -
Table 40. Pulpotomy (FS) versus pulpectomy (Sedanol)
Table 41. Pulpotomy (3Mix) versus pulpectomy (3Mix)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

3.00 (0.13, 70.83)

12

1

5.00 (0.25, 99.95)

Pain

6

1

3.00 (0.13, 70.83)

12

1

5.00 (0.25, 99.95)

Soft tissue pathology

6

1

Not estimable*

12

1

3.00 (0.13, 70.83)

Pathologic mobility

6 and 12

1

3.00 (0.13, 70.83)

Pathologic radiolucency

6

1

23.00 (1.42, 373.46)

12

1

11.00 (0.64, 190.53)

*due to lack events

Abbreviations ‐ CI: confidence interval; 3Mix: ciprofloxacin + metronidazole + minocycline.

Figures and Tables -
Table 41. Pulpotomy (3Mix) versus pulpectomy (3Mix)
Table 42. Direct pulp capping (CH) versus direct pulp capping (FC)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

24

1

3.83 (1.68 to 8.74)

Radiological failure

24

1

3.11 (1.61 to 6.02)

Pain

6

1

7.00 (0.37 to 132.66)

12

1

9.00 (0.50 to 163.59)

24

1

4.00 (0.89 to 18.06)

Soft tissue pathology

6

1

7.00 (0.37 to 132.66)

12

1

2.5 (0.50 to 12.39)

24

1

1.8 (0.64 to 5.06)

Pathological radiolucency

6

1

Not estimable*

12

1

4.00 (0.46 to 34.75)

24

1

5.00 (1.14 to 21.86)

Pathological root resorption

6

1

Not estimable*

12

1

3.33 (0.96 to 11.51)

24

1

2.00 (0.87 to 4.60)

*due to lack of events

Abbreviations ‐ CH: calcium hydroxide; CI: confidence interval; FC: formocresol.

Figures and Tables -
Table 42. Direct pulp capping (CH) versus direct pulp capping (FC)
Table 43. Direct pulp capping (total‐etching with 36% phosphoric acid + acetone‐based total‐etch adhesive) versus direct pulp capping (CH)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Radiological failure

6

1

Not estimable*

12

1

3.00 (0.13 to 69.52)

24

1

7.00 (0.38 to 127.33)

Pain

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Pathological radiolucency

6

1

Not estimable*

12

1

3.00 (0.13 to 69.52)

24

1

7.00 (0.38 to 127.33)

Pathological root resorption

6, 12 and 24

1

Not estimable*

*due to lack of events

Abbreviations ‐ CH: calcium hydroxide; CI: confidence interval

Figures and Tables -
Table 43. Direct pulp capping (total‐etching with 36% phosphoric acid + acetone‐based total‐etch adhesive) versus direct pulp capping (CH)
Table 44. Direct pulp capping (self etch adhesive system + acetone‐based total‐etch adhesive) versus direct pulp capping (CH)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6, 12 and 24

1

3.00 (0.13 to 69.52)

Radiological failure

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Pain

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Pathological radiolucency

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Pathological root resorption

6, 12 and 24

1

Not estimable*

*due to lack of events

Abbreviations ‐ CH: calcium hydroxide; CI: confidence interval

Figures and Tables -
Table 44. Direct pulp capping (self etch adhesive system + acetone‐based total‐etch adhesive) versus direct pulp capping (CH)
Table 45. Direct pulp capping (total‐etching with 36% phosphoric acid + acetone‐based total‐etch adhesive) versus direct pulp capping (acetone‐based total‐etch adhesive)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Radiological failure

6 and 12

1

3.00 (0.13 to 69.52)

24

1

7.00 (0.38 to 127.33)

Pain

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Pathological radiolucency

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Pathological root resorption

6, 12 and 24

1

Not estimable*

*due to lack of events

Abbreviation ‐ CI: confidence interval.

Figures and Tables -
Table 45. Direct pulp capping (total‐etching with 36% phosphoric acid + acetone‐based total‐etch adhesive) versus direct pulp capping (acetone‐based total‐etch adhesive)
Table 46. Direct pulp capping (self etch adhesive system + acetone‐based total‐etch adhesive) versus direct pulp capping (acetone‐based total‐etch adhesive)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6, 12 and 24

1

3.00 (0.13 to 69.52)

Radiological failure

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Pain

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Pathological radiolucency

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Pathological root resorption

6, 12 and 24

1

Not estimable*

*due to lack of events

Abbreviation ‐ CI: confidence interval

Figures and Tables -
Table 46. Direct pulp capping (self etch adhesive system + acetone‐based total‐etch adhesive) versus direct pulp capping (acetone‐based total‐etch adhesive)
Table 47. Direct pulp capping (total‐etching with 36% phosphoric acid + acetone‐based total‐etch adhesive) versus direct pulp capping (non‐rinse conditioner + acetone‐based total‐etch adhesive)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Radiological failure

6

1

Not estimable*

12

1

3.00 (0.13 to 69.52)

24

1

7.00 (0.38 to 127.33)

Pain

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Pathological radiolucency

6

1

Not estimable*

12

1

3.00 (0.13 to 69.52)

24

1

7.00 (0.38 to 127.33)

Pathological root resorption

6, 12 and 24

1

Not estimable*

*due to lack of events

Abbreviations ‐ CI: confidence interval.

Figures and Tables -
Table 47. Direct pulp capping (total‐etching with 36% phosphoric acid + acetone‐based total‐etch adhesive) versus direct pulp capping (non‐rinse conditioner + acetone‐based total‐etch adhesive)
Table 48. Direct pulp capping (self etch adhesive system + acetone‐based total‐etch adhesive) versus direct pulp capping (non‐rinse conditioner + acetone‐based total‐etch adhesive)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6, 12 and 24

1

3.00 (0.13 to 69.52)

Radiological failure

6

1

Not estimable*

12 and 24

1

1.00 (0.07 to 14.90)

Pain

6

1

Not estimable*

12 and 24

1

3.00 (0.13 to 69.52)

Pathological radiolucency

6

1

Not estimable*

12 and 24

1

1.00 (0.07 to 14.90)

Pathological root resorption

6, 12 and 24

1

Not estimable*

*due to lack of events

Abbreviation ‐ CI: confidence interval.

Figures and Tables -
Table 48. Direct pulp capping (self etch adhesive system + acetone‐based total‐etch adhesive) versus direct pulp capping (non‐rinse conditioner + acetone‐based total‐etch adhesive)
Table 49. Direct pulp capping (self etch adhesive system + acetone‐based total‐etch adhesive) versus direct pulp capping (total‐etching with 36% phosphoric acid + acetone‐based total‐etch adhesive)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

6

1

3.00 (0.13 to 69.52)

12 and 24

1

1.00 (0.07 to 14.90)

Radiological failure

6

1

0.33 (0.01 to 7.72)

12

1

1.00 (0.07 to 14.90)

24

1

0.33 (0.04 to 2.94)

Pain

6

1

Not estimable*

12

1

3.00 (0.13 to 69.52)

24

1

1.00 (0.07 to 14.90)

Pathological radiolucency

6

1

Not estimable*

12

1

1.00 (0.07 to 14.90)

24

1

0.33 (0.04 to 2.94)

Pathological root resorption

6, 12 and 24

1

Not estimable*

*due to lack of events

Abbreviation ‐ CI: confidence interval.

Figures and Tables -
Table 49. Direct pulp capping (self etch adhesive system + acetone‐based total‐etch adhesive) versus direct pulp capping (total‐etching with 36% phosphoric acid + acetone‐based total‐etch adhesive)
Table 50. Direct pulp capping (Dycal) versus direct pulp capping (Dentogen)

Outcome

Time point (months)

No. of studies

Risk ratio (95% CI)

Clinical failure

1, 3, 6

1

5.00 (0.26, 98.00)

9

1

7.00 (0.38, 127.32)

12

1

4.00 (0.49, 32.72)

Radiological failure

1, 3, 6

1

5.00 (0.26, 98.00)

9

1

3.00 (0.34, 26.45)

12

1

1.67 (0.46, 6.06)

Pain

1, 3, 6, 9

1

Not estimable*

12

1

3.00 (0.13, 69.52)

Soft tissue pathology

1, 3, 6, 9

1

5.00 (0.26, 98.00)

12

1

2.00 (0.20, 20.33)

Pathologic mobility

1, 3, 6, 9

1

5.00 (0.26, 98.00)

12

1

2.00 (0.20, 20.33)

Pathologic radiolucency

1, 3, 6

1

5.00 (0.26, 98.00)

9

1

3.00 (0.34, 26.45)

12

1

1.33 (0.34, 5.21)

Pathologic root resorption

1, 3, 6

1

5.00 (0.26, 98.00)

9

1

2.00 (0.20, 20.33)

12

1.33 (0.34, 5.21)

*due to lack of events

Abbreviation ‐ CI: confidence interval.

Figures and Tables -
Table 50. Direct pulp capping (Dycal) versus direct pulp capping (Dentogen)
Comparison 1. Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

14

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

13

1048

Risk Ratio (M‐H, Fixed, 95% CI)

0.37 [0.07, 1.89]

1.2 12 months

12

740

Risk Ratio (M‐H, Fixed, 95% CI)

0.31 [0.10, 0.93]

1.3 24 months

9

548

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.18, 1.19]

2 Radiological failure Show forest plot

13

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

12

922

Risk Ratio (M‐H, Fixed, 95% CI)

0.38 [0.17, 0.86]

2.2 12 months

12

740

Risk Ratio (M‐H, Fixed, 95% CI)

0.41 [0.19, 0.89]

2.3 24 months

9

548

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.22, 0.80]

3 Overall failure Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

6

328

Risk Ratio (M‐H, Fixed, 95% CI)

0.23 [0.04, 1.32]

3.2 12 months

6

328

Risk Ratio (M‐H, Fixed, 95% CI)

0.48 [0.17, 1.36]

3.3 24 months

7

368

Risk Ratio (M‐H, Fixed, 95% CI)

0.50 [0.25, 1.01]

4 Pain Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

6

390

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

4.2 12 months

6

410

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.18]

4.3 24 months

4

290

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.14, 3.56]

5 Soft tissue pathology Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

7

410

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

5.2 12 months

7

430

Risk Ratio (M‐H, Fixed, 95% CI)

0.22 [0.05, 1.01]

5.3 24 months

5

310

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.04, 3.10]

6 Pathological mobility Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

5

250

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 12 months

4

200

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.97]

6.3 24 months

3

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Pathological radiolucency Show forest plot

14

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

13

1010

Risk Ratio (M‐H, Fixed, 95% CI)

0.54 [0.27, 1.08]

7.2 12 months

11

652

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.19, 0.98]

7.3 24 months

8

460

Risk Ratio (M‐H, Fixed, 95% CI)

0.55 [0.25, 1.22]

8 Pathological root resorption Show forest plot

12

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 6 months

11

866

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.18, 1.21]

8.2 12 months

9

508

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.07, 1.03]

8.3 24 months

6

338

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.08, 0.81]

9 Pulp canal obliteration Show forest plot

9

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 6 months

9

712

Risk Ratio (M‐H, Fixed, 95% CI)

1.52 [1.00, 2.30]

9.2 12 months

7

410

Risk Ratio (M‐H, Fixed, 95% CI)

1.70 [0.81, 3.57]

9.3 24 months

6

338

Risk Ratio (M‐H, Fixed, 95% CI)

2.05 [1.07, 3.94]

10 Dentin bridge formation Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 6 months

3

322

Risk Ratio (M‐H, Fixed, 95% CI)

18.16 [3.63, 90.91]

10.2 12 months

2

70

Risk Ratio (M‐H, Fixed, 95% CI)

6.0 [0.76, 47.22]

10.3 24 months

2

70

Risk Ratio (M‐H, Fixed, 95% CI)

6.0 [0.76, 47.22]

11 Physiological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 6 months

2

170

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.2 12 months

2

170

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.3 24 months

2

170

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.81]

Figures and Tables -
Comparison 1. Mineral trioxide aggregate (MTA) pulpotomy versus full strength or 1:5 diluted formocresol pulpotomy
Comparison 2. Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

6

538

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.09, 5.64]

1.2 12 months

5

432

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.12, 1.68]

1.3 24 months

3

290

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.04, 3.14]

2 Radiological failure Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

4

362

Risk Ratio (M‐H, Fixed, 95% CI)

0.29 [0.05, 1.79]

2.2 12 months

5

432

Risk Ratio (M‐H, Fixed, 95% CI)

0.28 [0.08, 0.98]

2.3 24 months

3

290

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.06, 0.67]

3 Pain Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

3.2 12 months

3

260

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.18]

3.3 24 months

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.04, 3.14]

4 Soft tissue pathology Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

4.2 12 months

3

260

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.18]

4.3 24 months

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

5 Pathological radiolucency Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

4

388

Risk Ratio (M‐H, Fixed, 95% CI)

0.16 [0.01, 2.95]

5.2 12 months

4

332

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.16, 2.38]

5.3 24 months

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.11, 1.95]

6 Pathological root resorption Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

3

316

Risk Ratio (M‐H, Fixed, 95% CI)

0.11 [0.01, 1.95]

6.2 12 months

3

260

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

6.3 24 months

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.13 [0.02, 0.98]

7 Pulp canal obliteration Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

2

192

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.2 12 months

2

192

Risk Ratio (M‐H, Fixed, 95% CI)

12.76 [0.79, 206.70]

Figures and Tables -
Comparison 2. Mineral trioxide aggregate (MTA) pulpotomy versus full strength formocresol pulpotomy
Comparison 3. Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

8

560

Risk Ratio (M‐H, Fixed, 95% CI)

0.16 [0.01, 3.06]

1.2 12 months

7

308

Risk Ratio (M‐H, Fixed, 95% CI)

0.16 [0.02, 1.28]

1.3 24 months

6

258

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.18, 1.42]

2 Radiological failure Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

8

560

Risk Ratio (M‐H, Fixed, 95% CI)

0.41 [0.17, 1.03]

2.2 12 months

7

308

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.20, 1.53]

2.3 24 months

6

258

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.31, 1.46]

3 Pain Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

4

200

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 12 months

3

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 24 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 70.30]

4 Soft tissue pathology Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

5

220

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 12 months

4

170

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.02, 1.65]

4.3 24 months

3

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.72]

5 Pathological mobility Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

4

180

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.97]

5.3 24 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Pathological radiolucency Show forest plot

9

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

9

622

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.30, 1.27]

6.2 12 months

7

320

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.13, 1.02]

6.3 24 months

6

270

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.23, 1.57]

7 Pathological root resorption Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

8

550

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.24, 1.99]

7.2 12 months

6

248

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.05, 1.14]

7.3 24 months

4

148

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.10, 1.92]

8 Pulp canal obliteration Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 6 months

7

520

Risk Ratio (M‐H, Fixed, 95% CI)

1.52 [1.00, 2.30]

8.2 12 months

5

218

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.44, 2.26]

8.3 24 months

5

218

Risk Ratio (M‐H, Fixed, 95% CI)

1.97 [0.99, 3.89]

Figures and Tables -
Comparison 3. Mineral trioxide aggregate (MTA) pulpotomy versus 1:5 diluted formocresol pulpotomy
Comparison 4. Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

4

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.08 [0.00, 1.31]

1.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.97]

1.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.52 [0.20, 1.39]

2 Radiological failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

4

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.06 [0.01, 0.40]

2.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.15, 3.44]

2.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.25, 1.36]

3 Overall failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

4

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.06 [0.01, 0.40]

3.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.15, 3.44]

3.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.32, 1.89]

4 Pain Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

3

160

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.00]

4.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Soft tissue pathology Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.00]

6 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.08 [0.00, 1.31]

7 Pathologic radiolucency Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

3

160

Risk Ratio (M‐H, Fixed, 95% CI)

0.03 [0.00, 0.48]

7.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.81]

7.3 24 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.97]

8 Pathological root resorption Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 6 months

4

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.07 [0.01, 0.53]

8.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.97]

8.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.12, 2.51]

9 Pulp canal obliteration Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 6 months

3

140

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.2 12 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 70.30]

9.3 24 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

1.57 [0.47, 5.27]

Figures and Tables -
Comparison 4. Mineral trioxide aggregate (MTA) pulpotomy versus ferric sulphate (FS) pulpotomy
Comparison 5. Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

4

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.85]

1.2 12 months

4

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.16 [0.04, 0.70]

1.3 24 months

5

284

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.12, 0.52]

2 Radiological failure Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

4

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.08 [0.02, 0.41]

2.2 12 months

4

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.12 [0.04, 0.36]

2.3 24 months

5

284

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.08, 0.26]

3 Overall failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

2

68

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.92]

3.2 12 months

2

68

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.10, 1.19]

3.3 24 months

2

68

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.18, 0.95]

4 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 24 months

2

196

Risk Ratio (M‐H, Fixed, 95% CI)

0.41 [0.09, 1.73]

5 Soft tissue pathology Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

3

122

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.02, 1.62]

5.2 12 months

3

122

Risk Ratio (M‐H, Fixed, 95% CI)

0.12 [0.02, 0.62]

5.3 24 months

4

256

Risk Ratio (M‐H, Fixed, 95% CI)

0.17 [0.06, 0.47]

6 Pathological mobility Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

3

122

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.02, 1.62]

6.2 12 months

3

122

Risk Ratio (M‐H, Fixed, 95% CI)

0.09 [0.01, 0.66]

6.3 24 months

4

256

Risk Ratio (M‐H, Fixed, 95% CI)

0.09 [0.01, 0.66]

7 Pathological radiolucency Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

4

162

Risk Ratio (M‐H, Fixed, 95% CI)

0.10 [0.02, 0.50]

7.2 12 months

4

162

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.04, 0.47]

7.3 24 months

5

296

Risk Ratio (M‐H, Fixed, 95% CI)

0.08 [0.03, 0.22]

8 Pathological root resorption Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 6 months

5

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.10 [0.02, 0.39]

8.2 12 months

5

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.07 [0.02, 0.29]

8.3 24 months

6

324

Risk Ratio (M‐H, Fixed, 95% CI)

0.08 [0.03, 0.18]

9 Pulp canal obliteration Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 6 months

3

120

Risk Ratio (M‐H, Fixed, 95% CI)

7.77 [1.56, 38.69]

9.2 12 months

3

120

Risk Ratio (M‐H, Fixed, 95% CI)

2.01 [0.97, 4.17]

9.3 24 months

4

254

Risk Ratio (M‐H, Fixed, 95% CI)

2.05 [1.01, 4.19]

10 Dentin bridge formation Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 6 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.05, 0.84]

10.2 12 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.8 [0.37, 1.74]

10.3 24 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.8 [0.37, 1.74]

Figures and Tables -
Comparison 5. Mineral trioxide aggregate (MTA) pulpotomy versus calcium hydroxide pulpotomy
Comparison 6. Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.02]

1.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.02]

1.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.02]

2 Radiological failure Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.10, 2.56]

3 Pain Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

3.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

3.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

4 Soft tissue pathology Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.02]

4.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.02]

4.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.02]

5 Pathologic mobility Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

5.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

5.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

6 Pathological radiolucency Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.12, 3.75]

7 Pathological root resorption Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.2 12 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 24 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.91]

8 Pulp canal obliteration Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 6 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.49, 1.08]

8.2 12 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.60, 1.14]

8.3 24 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.71, 1.29]

9 Dentin bridge formation Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 6 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.13, 2.43]

9.2 12 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.61, 3.71]

9.3 24 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.61, 3.71]

Figures and Tables -
Comparison 6. Mineral trioxide aggregate (MTA) pulpotomy versus Portland cement pulpotomy
Comparison 7. Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

4

234

Risk Ratio (M‐H, Fixed, 95% CI)

1.72 [0.42, 6.99]

1.2 12 months

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.16, 3.62]

2 Radiological failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

4

234

Risk Ratio (M‐H, Fixed, 95% CI)

2.40 [0.65, 8.84]

2.2 12 months

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.22, 5.27]

3 Pain Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.26, 98.00]

4 Soft tissue pathology Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.26, 98.00]

5 Pathologic mobility Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.26, 98.00]

6 Pathological radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

3.46 [0.15, 81.36]

6.2 12 months

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.19, 6.27]

7 Pathological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

2.32 [0.22, 24.09]

7.2 12 months

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.30, 4.19]

Figures and Tables -
Comparison 7. Biodentine pulpotomy versus Mineral trioxide aggregate (MTA) pulpotomy
Comparison 8. Calcium hydroxide pulpotomy versus formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

6

332

Risk Ratio (M‐H, Fixed, 95% CI)

1.98 [1.17, 3.37]

1.2 12 months

6

332

Risk Ratio (M‐H, Fixed, 95% CI)

1.87 [1.22, 2.89]

1.3 24 months

3

150

Risk Ratio (M‐H, Fixed, 95% CI)

2.18 [0.78, 6.11]

2 Radiological failure Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

4

154

Risk Ratio (M‐H, Fixed, 95% CI)

15.48 [3.86, 62.06]

2.2 12 months

6

332

Risk Ratio (M‐H, Fixed, 95% CI)

1.86 [1.42, 2.44]

2.3 24 months

3

150

Risk Ratio (M‐H, Fixed, 95% CI)

3.63 [1.73, 7.61]

3 Overall failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 12 months

2

120

Risk Ratio (M‐H, Fixed, 95% CI)

2.41 [0.80, 7.21]

3.2 24 months

2

120

Risk Ratio (M‐H, Fixed, 95% CI)

2.93 [1.35, 6.34]

4 Pain Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

4

276

Risk Ratio (M‐H, Fixed, 95% CI)

3.18 [0.35, 29.08]

4.2 12 months

4

276

Risk Ratio (M‐H, Fixed, 95% CI)

6.30 [1.15, 34.40]

5 Soft tissue pathology Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

5

306

Risk Ratio (M‐H, Fixed, 95% CI)

5.14 [0.63, 42.25]

5.2 12 months

5

306

Risk Ratio (M‐H, Fixed, 95% CI)

6.77 [1.23, 37.10]

5.3 24 months

2

124

Risk Ratio (M‐H, Fixed, 95% CI)

2.64 [0.51, 13.55]

6 Pathological mobility Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

4

238

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.18, 8.19]

6.2 12 months

4

238

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.40, 3.31]

6.3 24 months

2

124

Risk Ratio (M‐H, Fixed, 95% CI)

9.0 [0.53, 153.79]

7 Pathological radiolucency Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

3

128

Risk Ratio (M‐H, Fixed, 95% CI)

3.78 [0.64, 22.17]

7.2 12 months

5

306

Risk Ratio (M‐H, Fixed, 95% CI)

1.90 [0.67, 5.40]

7.3 24 months

2

124

Risk Ratio (M‐H, Fixed, 95% CI)

3.24 [0.79, 13.28]

8 Pathological root resorption Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 6 months

4

154

Risk Ratio (M‐H, Fixed, 95% CI)

11.87 [2.33, 60.40]

8.2 12 months

6

332

Risk Ratio (M‐H, Fixed, 95% CI)

6.25 [2.04, 19.14]

8.3 24 months

3

150

Risk Ratio (M‐H, Fixed, 95% CI)

4.59 [1.33, 15.81]

9 Pulp canal obliteration Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 6 months

2

56

Risk Ratio (M‐H, Fixed, 95% CI)

4.0 [0.47, 33.75]

9.2 12 months

3

140

Risk Ratio (M‐H, Fixed, 95% CI)

2.68 [0.91, 7.95]

10 Dentin bridge formation Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 6 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

13.0 [1.81, 93.60]

10.2 12 months

2

60

Risk Ratio (M‐H, Fixed, 95% CI)

14.0 [1.95, 100.26]

Figures and Tables -
Comparison 8. Calcium hydroxide pulpotomy versus formocresol pulpotomy
Comparison 9. Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

3.4 [0.14, 81.38]

1.2 12 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

3.41 [0.37, 31.61]

1.3 24 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

3.44 [0.90, 13.18]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 12 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.53, 3.13]

2.2 24 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

1.97 [1.04, 3.75]

3 Overall failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 12 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.53, 3.13]

3.2 24 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

1.97 [1.04, 3.75]

4 Pathological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 12 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.05, 6.05]

4.2 24 months

2

122

Risk Ratio (M‐H, Fixed, 95% CI)

2.29 [0.60, 8.66]

Figures and Tables -
Comparison 9. Calcium hydroxide pulpotomy versus ferric sulphate pulpotomy
Comparison 10. Ferric sulphate pulpotomy versus formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

7

394

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.15, 6.87]

1.2 12 months

7

394

Risk Ratio (M‐H, Fixed, 95% CI)

1.38 [0.45, 4.27]

1.3 24 months

5

258

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.40, 1.70]

2 Radiological failure Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

6

294

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.32, 1.92]

2.2 12 months

7

394

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.73, 2.42]

2.3 24 months

5

258

Risk Ratio (M‐H, Fixed, 95% CI)

1.26 [0.71, 2.24]

3 Overall failure Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

4

184

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.12, 2.37]

3.2 12 months

5

284

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.51, 2.64]

3.3 24 months

4

228

Risk Ratio (M‐H, Fixed, 95% CI)

1.49 [0.74, 3.01]

4 Pain Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

4

230

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.58]

4.2 12 months

4

230

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.58]

4.3 24 months

4

230

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.85]

5 Pathological radiolucency Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 12 months

4

230

Risk Ratio (M‐H, Fixed, 95% CI)

1.8 [0.40, 8.17]

5.2 24 months

4

230

Risk Ratio (M‐H, Fixed, 95% CI)

2.2 [0.51, 9.50]

6 Pathological root resorption Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

5

214

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.12, 3.84]

6.2 12 months

6

314

Risk Ratio (M‐H, Fixed, 95% CI)

1.64 [0.53, 5.08]

6.3 24 months

5

258

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.50, 2.96]

7 Pulp canal obliteration Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

3

134

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.2 12 months

3

134

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.54, 1.64]

7.3 24 months

2

78

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.28, 5.54]

Figures and Tables -
Comparison 10. Ferric sulphate pulpotomy versus formocresol pulpotomy
Comparison 11. Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

4.39 [0.22, 87.82]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.55 [0.22, 1.39]

2.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.17, 1.02]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Soft tissue pathology Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.29 [0.01, 6.91]

5 Adjacent tissue inflammation Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.31 [0.03, 2.91]

6 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Pathologic radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.06, 13.35]

7.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.07, 4.17]

8 Pathologic root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.18, 1.42]

8.2 12 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

0.38 [0.15, 1.01]

Figures and Tables -
Comparison 11. Sodium hypochlorite (NaOCl) pulpotomy versus ferric sulfate (FS) pulpotomy
Comparison 12. Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.23 [0.04, 1.30]

1.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.02, 1.62]

2 Radiological failure Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

3

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.38, 2.12]

2.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.44, 1.92]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.03, 1.60]

4 Pathological radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.08]

5 Pathological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.29, 7.73]

Figures and Tables -
Comparison 12. Diode laser pulpotomy versus ferric sulfate (FS) pulpotomy
Comparison 13. Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.13, 2.34]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.38, 4.12]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.13, 2.34]

4 Pathological mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Pathological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

2.2 [0.54, 8.88]

6 Pulp canal obliteration Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 13. Electrosurgery pulpotomy versus ferric sulfate (FS) pulpotomy
Comparison 14. Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.37, 4.27]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.16, 6.20]

2.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.34, 2.23]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.15, 6.71]

4 Soft tissue pathology Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.27, 8.43]

5 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Pathologic radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.12, 3.75]

7 Pathologic root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.26, 96.13]

7.2 12 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.31, 3.23]

Figures and Tables -
Comparison 14. Ankaferd Blood Stopper (ABS) versus Ferric Sulfate (FS) pulpotomy
Comparison 15. Diode laser pulpotomy versus electrosurgery pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.70]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.19, 2.18]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.70]

4 Pathological mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Pathological radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Pathological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.19, 2.18]

7 Pulp canal obliteration Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 15. Diode laser pulpotomy versus electrosurgery pulpotomy
Comparison 16. Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.33, 5.08]

2.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.86 [0.52, 6.59]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Soft tissue pathology Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Pathologic radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Pathologic root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.33, 5.08]

7.2 12 months

2

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.86 [0.52, 6.59]

Figures and Tables -
Comparison 16. Sodium hypochlorite (NaOCl) pulpotomy versus 1:5 diluted formocresol pulpotomy
Comparison 17. Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.8 [0.23, 2.83]

2 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.4 [0.08, 1.92]

3 Soft tissue pathology Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

2.0 [0.19, 21.06]

4 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.26, 96.13]

Figures and Tables -
Comparison 17. Enamel matrix derivative (EMD) pulpotomy versus formocresol pulpotomy
Comparison 18. Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

2.5 [0.50, 12.50]

2 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.14, 6.90]

3 Pathological mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.14, 6.90]

4 Pathological radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

2

110

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.26, 8.72]

5 Pathological radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

2

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.08]

Figures and Tables -
Comparison 18. Calcium hydroxide pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy
Comparison 19. Metapex versus zinc oxide eugenol (ZOE) pulpectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

2

62

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.08, 4.29]

1.2 12 months

2

62

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.15, 3.33]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

2

62

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.31, 3.27]

2.2 12 months

2

62

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.31, 3.27]

Figures and Tables -
Comparison 19. Metapex versus zinc oxide eugenol (ZOE) pulpectomy
Comparison 20. Metapex pulpectomy versus Endoflas pulpectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clincal failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.58]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

2.02 [0.79, 5.15]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.58]

4 Soft tissue pathology Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.58]

5 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Pathological radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

2.02 [0.79, 5.15]

7 Pathological root resorption Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 6 months

2

92

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 20. Metapex pulpectomy versus Endoflas pulpectomy
Comparison 21. Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

4

287

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.84]

1.2 12 months

4

287

Risk Ratio (M‐H, Fixed, 95% CI)

4.75 [1.21, 18.55]

2 Radiological failure Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

4

287

Risk Ratio (M‐H, Fixed, 95% CI)

2.36 [0.86, 6.50]

2.2 12 months

4

287

Risk Ratio (M‐H, Fixed, 95% CI)

6.56 [2.58, 16.67]

3 Overall failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

2

140

Risk Ratio (M‐H, Fixed, 95% CI)

1.89 [0.63, 5.66]

3.2 12 months

2

140

Risk Ratio (M‐H, Fixed, 95% CI)

2.56 [0.89, 7.32]

4 Pain Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 12 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Pathological mobility Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.84]

5.2 12 months

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.07, 15.18]

Figures and Tables -
Comparison 21. Vitapex pulpectomy versus zinc oxide and eugenol (ZOE) pulpectomy
Comparison 22. Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinical failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 6 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.05, 1.50]

2 Radiological failure Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 6 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.05, 1.50]

3 Pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 6 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.05, 1.50]

4 Pathologic mobility Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 6 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.16 [0.02, 1.25]

5 Pathologic radiolucency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 6 months

2

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.11, 3.63]

Figures and Tables -
Comparison 22. Endoflas pulpectomy versus zinc oxide eugenol (ZOE) pulpectomy