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Direct pulp capping procedures versus root canal treatment in young permanent vital teeth with pulp exposures due to caries: A systematic review
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0001-9300-2520
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0003-4290-2283
2016 (English)In: American Journal of Dentistry, ISSN 0894-8275, Vol. 29, no 4, p. 201-206Article, review/survey (Refereed) Published
Abstract [en]

Purpose: To evaluate the available evidence on pulp capping procedures and root canal treatment in young permanent teeth with vital pulps exposed by caries. Methods: The study was conducted as a systematic review of the literature. Three databases, PubMed, Web of Knowledge, and The Cochrane Library were searched. Reference lists of relevant articles were hand searched. The quality of all relevant publications was rated. Results: Ten original scientific studies were included in the review. The quality was rated as low in all studies. The search failed to disclose any article directly comparing pulp capping and root canal treatment. The level of evidence was insufficient to draw any conclusions regarding the effectiveness of the two treatment concepts. High success rates are reported for pulp capping procedures in exposure due to caries, though it is not possible to compare them to success rates of root canal treatment. The review confirms the lack of high quality studies on the treatment of young permanent teeth with cariously exposed pulps.

Place, publisher, year, edition, pages
Mosher & Linder , 2016. Vol. 29, no 4, p. 201-206
Keywords [en]
adolescent, child, dental caries, dental pulp capping, dental pulp exposure, root canal therapy
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-16193ISI: 000381956000004PubMedID: 29178748Local ID: 21686OAI: oai:DiVA.org:mau-16193DiVA, id: diva2:1419709
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2023-07-04Bibliographically approved
In thesis
1. Uncertainty in Endodontics: Strategies for Understanding and Management
Open this publication in new window or tab >>Uncertainty in Endodontics: Strategies for Understanding and Management
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Dentists often experience uncertainty when deciding on the most effective treatment for a particular patient. There are various sources of uncertainty and different strategies for coping with it, such as reducing or accepting it and learning how to make decisions despite feeling uncertain.

The overall objectives of the thesis are to contribute with information that reduces uncertainty regarding the treatment of cariously exposed pulps in young permanent teeth and to improve dental education to ensure that future dental students manage well despite uncertainty.

By means of a systematic review and a model analysis, the thesis evaluates the available evidence and cost-effectiveness of a pulp capping procedure compared to a root canal treatment to reduce the uncertainty regarding the cost-effectiveness of treatments for young permanent teeth with vital pulps exposed by caries.

The thesis also addresses the acceptance of uncertainty. A reflection exercise was developed and tested in a group of dental students. Prompts from an established model were used to stimulate the students to write reflections during the risk assessment of a root-filled tooth. The effect of the reflections on the student’s awareness of and comfort with uncertainty was explored with a repeated questionnaire. The written reflections were analyzed with a qualitative method to explore how dental students reflected on clinical experience in relation to uncertainty.

In the systematic review, the success rate for pulp capping in children and adolescents varied between 64 and 100 percent in the included studies. The model indicated that pulp capping procedures are cost-effective compared to root canal treatment in teeth with pulp exposure due to caries. Fewer teeth were extracted after a pulp capping during the 9 years the patients were followed in the model and the cost for the initial treatment and follow-up treatments during this time period was lower compared to a root canal treatment.

The reflection exercise had an effect on the students’ responses to the questions regarding how certain they believed an experienced colleague would feel, and how certain they felt of their capacity to handle the case. Most students did not state that they felt certain about assessing the risk for exacerbation of apical periodontitis in root-filled teeth but felt certain of their own capacity to handle the case, as well as comfortable with their ability to handle the situation and do their best for the patient.

Three themes about experience and lack of experience were identified in the reflections: “the meaning of clinical experience”, “assumed differences regarding assessment” and “relating to the same risk factors”.

The following conclusions were drawn from the four studies:

For children and adolescents with pulp exposure due to caries, pulp capping procedures are cost-effective compared to root canal treatment, but there is a lack of prospective studies concerning root canal treatment. Moreover, the existing studies on pulp capping procedures are of low quality.

Most final-year dental students participating in a reflection exercise did not feel certain of their risk assessment of root-filled teeth but still felt certain of their capacity to handle the situation, as well as comfortable with their ability to do the best for the patient. The students believed that clinical experience leads to certainty even when the scientific evidence is lacking and experts who meet students have a great responsibility to be transparent with their own uncertainty.

Abstract [sv]

När en tandläkare ska besluta om vilken behandling som är lämpligast för en patient finns det många källor till osäkerhet. För att hantera denna osäkerhet finns det olika strategier. Några möjliga strategier är att försöka minska osäkerheten eller att acceptera den och lära sig att fatta beslut trots att man känner sig osäker. 

Det är osäkert vilken behandling som är mest effektiv för unga patienter där ett kariesangrepp har gjort att tandpulpan har blivit blottad. Antingen kan man göra en fyllning direkt på den blottade tandpulpan så att den ges möjlighet att läka, en så kallad pulpaöverkappning, eller så kan man avlägsna pulpan och rotfylla tanden. Det finns för- och nackdelar med båda behandlingarna. Studier har visat att nästan hälften av alla rotfyllningar på barn och ungdomar är av tekniskt dålig kvalitet och att många tänder uppvisar inflammation vid rotspetsen. För att minska osäkerheten och jämföra de båda behandlingarna studerades publicerad relevant litteratur om de båda behandlingarna i en systematisk litteraturöversikt. Resultaten från studierna användes sedan i en hälsoekonomisk modell som visade att det var kostnadseffektivt med pulpaöverkappning jämfört med att avlägsna pulpan och rotfylla tanden. 

Trots att vissa former av osäkerhet går att minska så kommer tandläkare alltid behöva ha förmågan att kunna fatta beslut trots att man inte är säker. För att hjälpa tandläkarstudenter att känna trygghet med att ta beslut trots osäkerhet utvecklades och testades en reflektionsövning på en grupp tandläkarstudenter som gick sitt sista år på tandläkarutbildningen. Övningen bestod av skriftliga reflektioner om ett fall med en rotfylld tand där studenterna skulle bedöma risken för framtida akutisering av en kvarstående infektion. Med en upprepad enkät undersöktes om reflektionsövningen kunde påverka hur osäkra och hur bekväma studenterna kände sig. Innehållet i de skriftliga reflektionerna analyserades sedan med kvalitativ metod.

 

Slutsatserna är att: 

Det saknas studier om rotfyllning efter att tandpulpan blivit blottad på grund av karies på barn och ungdomar. 

För unga patienter med en permanent tand med blottad tandpulpa på grund av karies är pulpaöverkappning kostnadseffektivt jämfört med avlägsnande av pulpan och efterföljande rotfyllning.

De flesta tandläkarstudenter som deltog i reflektionsövningen kände sig inte säkra på riskbedömningen av rotfyllda tänder men kände sig samtidigt säkra på sin förmåga att hantera patientfallet och bekväma med att de gjorde det bästa för patienten. Reflektionsövningen påverkade hur studenterna svarade på hur osäkra de trodde att en expert skulle vara och på hur säkra de var på sin egen förmåga. 

Studenterna trodde att klinisk erfarenhet leder till säkerhet även i fall där det saknas vetenskapliga bevis. Därför är det viktigt att de erfarna tandläkare som undervisar studenter visar att även en expert kan vara osäker.

Place, publisher, year, edition, pages
Malmö: Malmö University Press, 2022. p. 69
Series
Doctoral Dissertation in Odontology
Keywords
endodontology, uncertainty, cost-effectiveness, dental education, vital pulp treatment
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-55467 (URN)10.24834/isbn.9789178773114 (DOI)978-91-7877-312-1 (ISBN)978-91-7877-311-4 (ISBN)
Public defence
2022-12-09, Aulan Odontologiska fakulteten, Malmö, 09:15 (English)
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Supervisors
Note

Note: The papers are not included in the fulltext online

Available from: 2022-11-10 Created: 2022-11-09 Last updated: 2024-03-01Bibliographically approved

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PubMedhttp://www.amjdent.com/Archive/2016/Broden%20AJD%20August%202016.pdf

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Brodén, JoséphineFransson, Helena

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