No definitive conclusion as to the most effective method of pulp treatment of asymptomatic carious teeth

Abstract

Data sources: The Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase, National Research Register and the Science Citation Index SCISEARCH were searched. Key journals were searched by hand, together with reference lists of review articles and endodontic textbooks. There was no language restriction.

Study selection: Randomised controlled trials (RCT) or quasi-RCT were included that compared techniques to maintain pulp vitality of asymptomatic permanent teeth with extensive caries. Outcome measures included clinical success and adverse events.

Data extraction and synthesis: Data were independently extracted by three review authors and, where necessary, further information was sought from the author. The quality of included studies was assessed using standard criteria.

Results: The search identified 34 studies of which four met the inclusion criteria. Interventions examined included: Ledermix (Wyeth Lederle, Denmark), glycerrhetinic acid/ antibiotic mix, zinc oxide eugenol, calcium hydroxide, Cavitec (Kerr Corporation, Orange, CA 92867), Life (DENTSPLY Caulk, Milford, DE 19963-0359), Dycal (DENTSPLY Caulk, Milford, DE 19963-0359)potassium nitrate, dimethyl isosorbide, and polycarboxylate cement. Only one study produced a statistically significant finding: potassium nitrate/ dimethyl isosorbide/ polycarboxylate cement resulted in fewer clinical symptoms than potassium nitrate/ polycarboxylate cement or polycarboxylate cement alone when used as a capping material for carious pulps.

Conclusions: The findings of this review suggest that there should not be any significant change from accepted conventional practice procedures when the pulp of the carious tooth is considered. Further well-designed RCT are needed to investigate the potential of contemporary materials which may be suitable when used in the management of carious teeth.