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Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions

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Purpose: This manuscript presents evidence-based guidance on the use of vital pulp therapies for treatment of deep caries lesions in children. A guideline panel convened by the American Academy of Pediatric Dentistry formulated evidence-based recommendations on three vital pulp therapies: indirect pulp treatment (IPT; also known as indirect pulp cap), direct pulp cap (DPC), and pulpotomy. Methods: The basis of the guideline's recommendations was evidence from "Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-Analysis." (Pediatr Dent 2017;15;39[1]:16-23.) A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and trial databases to identify randomized controlled trials and systematic reviews addressing peripheral issues of vital pulp therapies such as patient preferences of treatment and impact of cost. Quality of the evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation approach; the evidence-to-decision framework was used to formulate a recommendation. Results: The panel was unable to make a recommendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions. The panel recommends use of mineral trioxide aggregate (MTA) and formocresol in pulpotomy treatments; these are recommendations based on moderate-quality evidence at 24 months. The panel made weak recommendations regarding choice of medicament in both IPT (moderate-quality evidence [24 months], low quality evidence [48 months]) and DPC (very-low quality evidence [24 months]). Success of both treatments was independent of type of medicament used. The panel also recommends use of ferric sulfate (low-quality evidence), lasers (low-quality evidence), sodium hypochlorite (very low-quality evidence), and tricalcium silicate (very low-quality evidence) in pulpotomies; these are weak recommendations based on low-quality evidence. The panel recommended against the use of calcium hydroxide as pulpotomy medicament in primary teeth with deep caries lesions. Conclusions and practical implications: The guideline intends to inform the clinical practices with evidence-based recommendations on vital pulp therapies in primary teeth with deep caries lesions. These recommendations are based upon the best available evidence to-date.
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Keywords: CALCIUM HYDROXIDE; DIRECT PULP CAP; FERRIC SULFATE; FORMOCRESOL; INDIRECT PULP CAP; INDIRECT PULP TREATMENT; MINERAL TRIOXIDE AGGREGATE; PULP THERAPY; PULPOTOMY; SODIUM HYPOCHLORITE; TRICALCIUM SILICATE; VITAL PULP THERAPY

Document Type: Short Communication

Affiliations: 1: VPT workgroup chair, is a clinical associate professor and chief, Division of Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md., USA 2: Pediatric dental fellow, Division of Pediatric Dentistry, at the University of Maryland School of Dentistry, Baltimore, Md., USA 3: Clinical associate professor of pediatric dentistry, at NYU College of Dentistry, New York, N.Y., USA; and a pediatric dentist in private practice, in New Yersey, N.J. and New York City, N.Y., USA 4: Clinical associate professor of pediatric dentistry, at The Ohio State University College of Dentistry; and a director of Dental Clinic Operations, Nation-wide Children's Hospital, Columbus, Ohio, USA 5: Associate professor, Department of Pediatric Dentisry, at the Louisiana State University School of Dentistry New Orleans, La., USA 6: Full-time faculty, Department of Pediatric Dentistry, at Case Western Reserve University, School of Dental Medicine, Cleveland, Ohio, USA 7: Senior evidence-based dentistry manager, American Academy of Pediatric Dentistry, Chicago, Ill., USA;, Email: [email protected]

Publication date: September 1, 2017

More about this publication?
  • Pediatric Dentistry is the official publication of the American Academy of Pediatric Dentistry, the American Board of Pediatric Dentistry and the College of Diplomates of the American Board of Pediatric Dentistry. It is published bi-monthly and is internationally recognized as the leading journal in the area of pediatric dentistry. The journal promotes the practice, education and research specifically related to the specialty of pediatric dentistry. This peer-reviewed journal features scientific articles, case reports and abstracts of current pediatric dental research.
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