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Direct pulp capping versus pulpotomy with MTA for carious primary molars: a randomised clinical trial

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Abstract

Aim

Aim of this randomised clinical trial was to compare the outcome of direct pulp capping (DPC) versus pulpotomy, both with MTA, for carious primary molars.

Methods

Healthy, cooperative children aged 3–9 years with at least one deep carious primary molar requiring vital pulp therapy were included. Data on the primary outcome (all-cause failure) and secondary outcomes (clinical or radiographic failure) were collected blindly semi-annually for a minimum of 1 year up to 3 years and analysed with survival analysis and generalised linear regression at alpha = 5%.

Results

A total of 74 children were randomly allocated on 1:1 basis to DPC (35 children; 40 teeth) or pulpotomy (39 children; 57 teeth). Survival from all-cause failure was 79.7% [95% confidence interval (CI) 69.3–86.9%] at 12 months and 66.0% (95% CI 53.4–76.0%) at 24 months which remained stable up to 36 months, with no differences between groups (P > 0.05). No significant difference was found in the survival rate of the two groups for all-cause [hazard ratio (HR) = 0.95; 95% CI 0.45–2.01; P = 0.88], clinical (HR = 0.74; 95% CI 0.0.19–2.92; P = 0.66), or radiographic failure (HR = 0.80; 95% CI 0.0.36–1.82; P = 0.60) throughout the 3-year follow-up. Regression analysis indicated that needing a second attempt for haemorrhage control was associated with higher clinical failure rate. All-case failure was significantly different for class II versus occlusal cavities and in the latter cavities pulpotomy performed better (P < 0.001).

Conclusion

The results of the current trial indicate that both DPC and pulpotomy can be reliable options for the treatment of deep carious primary molars in cooperative children, in carefully selected cases.

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Acknowledgements

The authors would like to thank all postgraduate residents and clinic supervisors for their assistance in this study. The MTA used in the study procedures was provided by Medcem GmbH, Weinfelden, Switzerland. Preliminary results of this study were published in the 13th EAPD Congress in Belgrade and were awarded with the “Young Scientist Research Award”.

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Authors and Affiliations

  1. Department of Paediatric Dentistry, Dental School, University of Thessaloniki, Thessaloniki, Greece

    D. Dimitraki & N. Kotsanos

  2. Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland

    S. N. Papageorgiou

Authors
  1. D. Dimitraki
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  2. S. N. Papageorgiou
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  3. N. Kotsanos
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Correspondence to D. Dimitraki.

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Ethical approval

This study was approved by the Ethics Committee of the Aristotle University of Thessaloniki, Dental School (307/July 6, 2012).

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Dimitraki, D., Papageorgiou, S.N. & Kotsanos, N. Direct pulp capping versus pulpotomy with MTA for carious primary molars: a randomised clinical trial. Eur Arch Paediatr Dent 20, 431–440 (2019). https://doi.org/10.1007/s40368-019-00419-7

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