pulp therapy in young permanent den- tition: a …

Oren Munwes

5th year, group 13

PULP THERAPY IN YOUNG PERMANENT DEN-TITION: A SYSTEMATIC REVIEW

Master’s Thesis

Supervisor: Sandra Petrauskienė

Kaunas, 2019

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LITHUANIAN UNIVERSITY OF HEALTH SCIENCES

MEDICAL ACADEMY

FACULTY OF ODONTOLOGY

CLINIC FOR PREVENTIVE AND PEDIATRIC DENTISTRY

Pulp therapy in young permanent dentition: A SYSTEMATIC REVIEW

Master’s Thesis

The thesis was done

by student ................................................ Supervisor ............................................... (signature) (signature)

..................................................... ...................................................................

.......... (name surname, year, group) (degree, name surname)

.............................. 20…. .............................. 20…. (day/month) (day/month)

Kaunas, 2019

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EVALUATION TABLE OF THE MASTER’S THESIS

Evaluation: ..................................................................................................................................

Reviewer: ................................................................................................................................... (scientific degree. name and surname)

Reviewing date: ...........................................

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No. MT parts MT evaluation aspects

Compliance with MT requirements and

evaluation

Yes Partially

No

1Summary (0.5 point)

Is summary informative and in compliance with the thesis content and requirements?

0.3 0.1 0

2 Are keywords in compliance with the thesis essence?

0.2 0.1 0

3Introduc-tion, aim and tasks (1 point)

Are the novelty, relevance and significance of the work justified in the introduction of the thesis?

0.4 0.2 0

4 Are the problem, hypothesis, aim and tasks formed clearly and properly?

0.4 0.2 0

5 Are the aim and tasks interrelated? 0.2 0.1 0

6

Selection criteria of

the studies, search

methods and

strategy (3.4 points)

Is the protocol of systemic review present? 0.6 0.3 0

7Were the eligibility criteria of articles for the selected protocol determined (e.g., year, language, publication condition, etc.)

0.4 0.2 0

8

Are all the information sources (databases with dates of coverage, contact with study authors to identify additional studies) described and is the last search day indicated?

0.2 0.1 0

9

Is the electronic search strategy described in such a way that it could be repeated (year of search, the last search day; keywords and their combinations; number of found and se lec ted a r t i c l es accord ing to the combinations of keywords)?

0.4 0.1 0

10

Is the selection process of studies (screening, eligibility, included in systemic review or, if applicable, included in the meta-analysis) described?

0.4 0.2 0

11

Is the data extraction method from the articles (types of investigations, participants, interventions, analysed factors, indexes) described?

0.4 0.2 0

12Are all the variables (for which data were s o u g h t a n d a n y a s s u m p t i o n s a n d simplifications made) listed and defined?

0.4 0.2 0

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13

Are the methods, which were used to evaluate the risk of bias of individual studies and how this information is to be used in data synthesis, described?

0.2 0.1 0

14 Were the principal summary measures (risk ratio, difference in means) stated?

0.4 0.2 0

15

Systemiza-tion and

analysis of data

(2.2 points)

Is the number of studies screened: included upon assessment for eligibility and excluded upon giving the reasons in each stage of exclusion presented?

0.6 0.3 0

16

Are the characteristics of studies presented in the included articles, according to which the data were extracted (e.g., study size, follow-up period, type of respondents) presented?

0.6 0.3 0

17

Are the evaluations of beneficial or harmful outcomes for each study presented? (a) simple summary data for each intervention group; b) effect estimates and confidence intervals)

0.4 0.2 0

18Are the extracted and systemized data from studies presented in the tables according to individual tasks?

0.6 0.3 0

19

Discussion (1.4 points)

Are the main findings summarized and is their relevance indicated?

0.4 0.2 0

20 Are the limitations of the performed systemic review discussed?

0.4 0.2 0

21 Does author present the interpretation of the results?

0.4 0.2 0

22Conclusion

s (0.5 points)

Do the conclusions reflect the topic, aim and tasks of the Master’s thesis?

0.2 0.1 0

23 Are the conclusions based on the analysed material?

0.2 0.1 0

24 Are the conclusions clear and laconic? 0.1 0.1 0

25

References (1 point)

Is the references list formed according to the requirements?

0.4 0.2 0

26Are the links of the references to the text correct? Are the literature sources cited correctly and precisely?

0.2 0.1 0

27 Is the scientific level of references suitable for Master’s thesis?

0.2 0.1 0

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28Do the cited sources not older than 10 years old form at least 70% of sources, and the not older than 5 years – at least 40%?

0.2 0.1 0

Additional sections, which may increase the collected number of points

29 Annexes Do the presented annexes help to understand the analysed topic?

+0.2 +0.1 0

30Practical

recommen-dations

Are the practical recommendations suggested and are they related to the received results?

+0.4 +0.2 0

31Were additional methods of data analysis and their results used and described (sensitivity analyses, meta-regression)?

+1 +0.5 0

32Was meta-analysis applied? Are the selected statistical methods indicated? Are the results of each meta-analysis presented?

+2 +1 0

General requirements, non-compliance with which reduce the number of points

33

General require-ments

Is the thesis volume sufficient (excluding annexes)?

15-20 pages (-2 points)

<15 pages (-5 points)

34 Is the thesis volume increased artificially?

-2 points

-1 point

35 Does the thesis structure satisfy the requirements of Master’s thesis?

-1 point -2 points

36Is the thesis written in correct language, scientifically, logically and laconically?

-0.5 point -1 points

37 Are there any grammatical, style or computer literacy-related mistakes?

-2 points

-1 points

38Is text consistent, integral, and are the volumes of its structural parts balanced?

-0.2 point-0.5

points

39 Amount of plagiarism in the thesis. >20% (not evaluated)

40

Is the content (names of sections and sub-sections and enumeration of pages) in compliance with the thesis structure and aims?

-0.2 point -0.5 points

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*Remark: the amount of collected points may exceed 10 points. Reviewer’s comments:

Reviewer’s name and surname Reviewer’s signature

41

Are the names of the thesis parts in compliance with the text? Are the titles of sections and sub-sections distinguished logically and correctly?

-0.2 point-0.5

points

42 Are there explanations of the key terms and abbreviations (if needed)?

-0.2 point -0.5 points

43Is the quality of the thesis typography (quality of printing, visual aids, binding) good?

-0.2 point-0.5

points

*In total (maximum 10 points):

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TABLE OF CONTENTS

SUMMARY ………………………………………………………….……….…10.

INTRODUCTION ………………………………………………………………11.

SELECTION CRITERIA OF THE STUDIES. SEARCH METHODS AND STRATE-

GY……………………………………………………………..…….…………..13.

SYSTEMIZATION AND ANALYSIS OF DATA ……….………….………….15.

DISCUSSION …………………………………….………………….…………20.

CONCLUSIONS ………………………….……………………………………21.

REFERENCES …………………………………………………………………22.

ANNEXES …………………………..………………………………………….27.

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ABBREVIATIONS

RPL- resolution of periapical lesions

TCW- thickening of canal walls

CRD- continued root development

AC- apical closure

PRF- plateled rich fibrin

CR- case report

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Pulp therapy in young permanent dentition

SUMMARY

Objective: to evaluate the most proper dental materials and treatment method that are used

in pulp treatment of young permanent dentition.

Material and methods. According to the PRISMA guidelines, publications of this sys-

tematic review were selected through PUBMED. The comprehensive search was restricted

to English language articles, published from 2008 to 2018. In the results it was shown 97

publications (abstracts). Later, 54 articles related to the topic were revised, of which 18

consistent with the subject of this review were qualified regarding to PICOS criteria.

Results. In total 64 patients were included. The age of patients was from 6 to 16 years old.

Overall 80 teeth were treated, mainly due to reversible or irreversible pulpitis, apical

chronic periodontitis and necrotic pulp. During treatment process sodium hypochlorite so-

lution, saline, 17% EDTA, chlorhexidine were used as irrigators; Ca(OH)2 paste, and

pastes of various antibiotics were used as intermediate material; MTA and Biodentine was

used for obturation, respectively. Mostly in all cases resolution of periapical lesion,

thichkeninf of canal walls and continued root development was recorded.

Conclusion. This systematic review relealed that partial pulpotomy is proper method in

reversible or irreversible pulpitis cases and apexofication and regenerative endodontics

was widely used in necrotic pulp or apical chronic periodontitis cases when roots are not

fully developed. While many variations of irrigation agents, intermediate agents and obtu-

ration material were applied in used treatment protocols.

Key words: Immature tooth, open apex, pulpotomy, apexofication, apexogenesis, root canal

treatment.

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INTRODUCTION

Root development of permanent teeth continues from 1 to 4 years after their eruption in the

mouth [1]. During this period, teeth are considered to be immature [2, 3]. Especially in young

permanent teeth with immature roots, the pulp is integral to continue apexogenesis [4]. Thus,

pulp preservation is a primary goal for restorative treatment in the young permanent dentition

[5].

When pulp of immature tooth is irreversibly damaged due to various reasons such as caries or

trauma, later root development will be arrested, apices of root will remain open and thin

dentinal walls will be observed [2, 3].Therefore, root canal treatment of immature tooth with

pulp necrosis is a unique challenge to the dentist, because conventional endodontic treatment

has traditionally been difficult to achieve in tooth with open due to the absence of apical

constriction and a potential danger of root fracture during lateral condensation [6, 2, 7].

Root canal therapy is usually done for teeth with irreversible pulpitis, even the radicular pulp

is often free of infection in order to prevent further infection development of the root canal

system [8]. Subsequently, pulpotomy is kind of a vital pulp therapy methods when the coronal

portion of the inflamed pulp is removed and the radicular pulp is preserved to ensure the pulp

vitality [9].

Pulpotomy is performed with various materials based on their biocompatibility, sealing ability

and antimicrobial efficacy on contact with pulp tissues. Various materials, like Mineral

Trioxide Aggregate (MTA), Biodentine, Calcium-Enriched Mixture (CEM) have a high

biocompatibility, sealing abilities and inducing proliferation of the pulpal cells [10].

Biodentine has shown an equal efficacy to MTA and can be considered as an alternative pulp

capping material and formation of complete dentinal bridge [11]. Biodentine has shorter

setting time better compressive strength and sealing ability than MTA [12].

Apexofication is a proper method for immature permanent teeth with non-vital pulp [13].The

main drawbacks of apexification are remained thin canal walls,weakened dentine structure

due to degradation of the proteins and arrested root development, furthermore these teeth are

susceptable to root fracture, especially when a long-term treatment of non-setting calcium hy-

droxide in non-vital immature incisors was performed [14,15,16]. Meanwhile, apexofication

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with mineral trioxide aggregate (MTA) requires fewer visits,but dentinal walls remains thin

and probability for a failure of further root development is present [17,18].

Revascularization procedures are defined as a better treatment option than traditional

apexification procedures due to elongation of root and thickening of lateral canal walls due to

deposition of new dentine, root maturation due to generating vital tissue [19, 20, 21].

Meanwhile, there is no standardized protocol for regenerative endodontics procedures yet

[22]. Satisfactory results are reached due to a proper disinfection of the canal, a suitable

matrix for new tissue ingrowth and an effective seal material [15]. Although the

revascularization treatment is minimally invasive, but technically is challenging for dentists

[23].

The overall success of vital pulp therapy mainly depends on which technique is performed,

the inflammatory status of the teeth, the type of the agent which is used, the success criteria,

and the period of follow-up [24].

Aim- to assess the most suitable treatment methods and used dental materials for pulp therapy

when roots of teeth are not fully developed.

Objectives:

1. To search and select the publications for analysis according to the conclusion and exclu-

sion criteria.

2. To identify the most proper treatment methods and dental materials used in cases of pulp

therapy.

3. To evaluate the efficacy of special dental materials which are used in such procedures.

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SELECTION CRITERIA OF THE STUDIES. SEARCH METHODS AND STRATEGY

Literature search strategy.

According to the PRISMA guidelines, publications of this systematic review were selected

through PUBMED. The flowing key words and their combinations immature tooth, open

apex, pulpotomy, apexofication, apexogenesis, root canal treatment. The comprehensive

search was restricted to English language articles, published from 2008 to 2018. One in-

vestigator carried out the selection and evaluation of articles. In the results it was shown 97

publications (abstracts). If full-content publications were not accessible without purchasing

and duplicated articles were excluded. Later, 54 articles related to the topic were revised,

of which 18 consistent with the subject of this review were qualified regarding to PICOS

criteria.

After all information’s having collected and exclusions that have been made, the gathering

information was sufficient and efficient for the research project.

Selection criteria.

Inclusion criteria for the selection were the following children needed pulp therapy for

immature permanent tooth, studies performed on humans, studies in vivo, article written in

English language, articles published in last 10 years and follow up period >1 year.

Exclusion criteria were the following pulp treatment for primary tooth, endodontic treatment

permanent tooth with fully developed roots, follow up period < 1 year, abstract, conference

proceedings, commentaries, practice guidelines, studies performed on animals.

PICOS (eligibility criteria).

Participants were included if age was under 18 years old and gender did not play any role.

Pemanent eeth were included with not fully developed roots.

Clinical examinations (palpation, percussion) and radiographic examinations as evaluation

method were used in all publications.

Intervention: pulpotomy, pulp apexofication, regenerative endodontics treatment methods.

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Successful outcomes- resolution of periapical lesions, thickening of root walls, apical closure

of roots, continued root formation.

Risk of bias was high in majority of articles due to a low number of participants in majority of

selected articles (Case repots). Usually, authors did not focus on comparison between differ-

ent treatment methods, success rate was based on control radiographic and clinical examina-

tion findings.

Figure 1. illustrates by a flow chart the process of filtering (PRISMA flow diagram)

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Identification

Eligibility

Screening

Included

Records identified through database searching in Pubmed (n-97)

Full-text articles assessed for eligibility (n-49)

Records excluded as clearly irrelevant (n-48)

Studies included in qualitative synthesis (n-18)

Records screened (n=97)

Full-text articles excluded, (n=31)

SYSTEMISATION AND ANALYSIS OF DATA

The main findings of this systematic review are presented in Table 1.

A total 18 articles were analyzed, while 16 of them were case reports and 2 clinical

studies.

Al studies were performed in vivo.

The sample of subjects (patients) ranged from 1 to 20. Age of patient varied from 6 to

16 years old.

The number of treated teeth ranged from1 to 20; and overall 80 teeth were treated.

Premolars were the most prevalent treated teeth, while pulp therapy of incisors and

molars were less common with the following diagnosis apical chronic periodontitis or

necrotic pulp. Subsequently, follow-up period ranged from 1 to 5 years.

Outcome was assessed according to healing process in control x-ray, which was de-

scribed as a continued root development, healing of periodical lesion, apical closure,

thickening of canal walls.

Considering the type of treatment, partial pulpotomy (with Ca(OH)2- 2 articles; with

MTA- 1 article), apexofication (with MTA- 2 articles; with Ca(OH)2- 2 articles) and

regenerative endodontics (11 articles). In these studies various irrigation agents were

used like saline, 1.25-5.25% NaOHCl, 0.2% or 2% chlorhexidine, and 17% EDTA

(Table 2).

Partial pulpotomy did not required any intermediate agents and teeth were restored

with Ca(OH)2 paste or MTA and crown restoration with depend on esthetics need

(amalgam or composite filling) (Table 2).

Intermediate agents were used in apexofication and regenerative endodontics methods.

Furthermore, not only Ca(OH)2 based paste was used in apexofication methods, but

antibiotics pastes(containing of ciprofloxacin, metronidazoleand minocycline)as well.

Later MTA or/and guttapercha were used as obturation materials. The most proper

crown restoration material were composite restorations (Table 2).

Articles presented cases of regenerative endodontics showed the highest range of in-

termediate agents and obturation techniques. Various compositions of antibiotics were

used as an intermediate agents and paste of ciprofloxacin, metronidazoleand minocy-

cline was the most common choice of authors. Moreover, the main principle of obtura-

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tion technique could be defined as blood clot formation or PRF (plateled rich fibrin)

inserting into apical part of canal and applying MTA or Biodentine above the clot. In

addition, in some cases gutta-percha was used after setting of MTA. Finally, restora-

tion material did not differ from other treatment methods and composite (with GIC or

without GIC lining), metal crowns (Table 2).

Table 1. The main descriptions of articles included into systamatic review.

Author, year

Type of study

Sample size

Age Tooth Reason Treatment method

Follow up (years)

Outcomes

Soares et al., 2012

CR 1 9 Incisor Trauma (subluxation)

Apexoficationwith Ca(OH)2

5 RPL TCW CRD

Chen et al., 2011

Clinical study

20 8-13 Premolar incisors

Apical chronic periodontitis

Regenerative endodontics

1-2.2 RPL (100%) TCW (100%) CRD (75%)

Sharma et al., 2016

CR 1 16 Incisor Apical chronic periodontitis (Trauma)

Apexoficationwith MTA

1 RPL

Kottoor et al., 2013



5 TCW CRD AC

Bacaksiz et al., 2013

CR 1 11 Premolar Reversible pulpitis

Partial pulpotomy with Ca(OH)2

1 CRD AC

Kim et al., 2012

CR 3 10-12 Premolars



2-4 TRW (100%) CRD (33%)

Li et al., 2016

Clinical study

20 8-12 Premolars

Necrotic pulp Regenerative endodontics

1 Regained responsiveness to the pulp (25%) RPL (90%) AC (60%)

López et al., 2017

CR 5 6.5-8 Molars; Incisor

Trauma (subluxation); Symptomatic pulpitis; Apical chronic periodontitis


1-1.5 RPL (100%); TDW (100%); AC; Canal obliteration (40% of teeth)

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Raju et al., 2014

CR 1 12 Premolar Apical chronic periodontitis


1 TDW; AC: A mineralized bridge developed beneath the MTA

Mishra et al., 2013



1 HPL; CRD; AC

Aldakaket al., 2016

CR 1 11 Premolar Pulp necrosis Regenerative endodontics

2 Complete root maturation.

Forghani et al., 2013

CR. 2 9 Incisors Apical chronic periodontitis* Irreversible pulpitis** (Trauma*,**)

Regenerative endodontics*

Pulpotomy**

1.5 RPL*; CRD*,**; AC*,**;

Sachdeva et al., 2015

CR 1 16 Incisor Necrotic pulp Regerative endodontics

3 TRW; CRD; AC

Keswaniet al., 2013

CR 1 7 Incisor Necrotic pulp (Trauma)


1.25 CRD; AC

Jung et al, 2008

CR 9 9-14 Premolars

Necrotic pulp; Apical chronic periodontitis

Apexofication Regenerative endodontics

1-5 RPL; TCW; CRD; AC

Tsukiboshiet al., 2017

CR 3 12 Premolars


Partial pulpotomy with Ca(OH)2p

1.3-5 RPL; TCW; AC

Topcuoglu,et al, 2016

CR 3 8-9 Molars Necrotic pulp Regerative endodontics

1.5 TCW; AC

Petrino et al., 2010

CR 6 6-13 Incisors, Premolars

Apical chronic periodontitis (trauma, in incisors)


1 RPL (100%). TRW (83%)

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Table 2. Dental materials used in different methods of pulp therapy

Treatment method

Irigation materials Intermediate agent (between visits)

Canal obturation material

Tooth restoration material

Partial pulpotomy

Partial pulpotomy with Ca(OH)2p [28, 37]

Saline [28] 2% NaOHCl [37]

Ca(OH)2paste [28] GIC and amalgam [28] Composite [37]

Pulpotomy with MTA [34]

5% NaOHCl [34] MTA [34] Composite [34]

Apexofication

Apexofication with MTA [21, 27]

NaOHCl 1.25% [27]; 5.25% [21]; 17% EDTA

Ca(OH)2 paste [21, 27]

Paste of ciprofloxacin, metronidazole, and minocycline [21]

MTA apical plug with PRF as an internal matrix and obturation with Gutta-percha using lateral obturation [21].

MTA was placed in to root canal over apical tissue [27]

Composite [21, 27]

Apexofication with Ca(OH)2 [21, 25]

2% chlorhexidine gel, saline, 17% EDTA [25]

5.25% NaOHCl [21]

Past mixture of calcium hydroxide and 2% chlorhexidine gel and zinc oxide in a 2:1:2 proportion [25]

1v- Paste of ciprofloxacin, metronidazole, and minocycline; 2v- erythromycin and Ca(OH)2, 3, 4v- Ca(OH)2p [21]

Gutta-percha [21, 25] Modeled fiber glass post and composite [25] Composite [21]


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Regenerative endodontics [3, 6, 22, 23, 26, 29, 30, 31, 32, 33, 35]

NaOHCL- 2.5% [3, 21, 22, 30, 32] 3% [29] 5% [31] 5.25% [6, 23, 26, 33, 34, 35, 36]

17% EDTA [33, 22]

0.12%chlorhexidine [23] 2% chlorhexidine [33] Saline [33, 22, 23]

Calcium hydroxide paste [26, 30]

Ciprofloxacin, metronidazole, and minocycline [6, 21, 23, 31, 32, 34, 35, 36]

Metronidazole ciprofloxacin and cefaclor [29]

Triple antibiotics paste [3]

Bleeding was induced into the canal space by K-file, coronal canal space was sealed with MTA (6, 21, 23, 26, 30, 32, 34]

Bleeding was induced into the canal space by K-file, coronal canal MTA was sealed over the blood clot, remained space of canal was obturated with Obtura II [29]

Bleeding was induced into the canal space by K-file, coronal canal space was sealed with Biodentine [33, 22]

PRF (Plateled rich fibrin) clot in the apical region and MTA in the cervical region [3, 35, 36]

Composite [22, 23, 26, 29, 32, 34, 36]

GIC and composite [6, 30, 31, 33, 35]

GIC, composite and metal crown [31]

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DISCUSSION

This systematic review showed that authors presented many variations of pulp

therapy in young permanent dentition. Subsequently, a partial pulpotomy as a

treatment method had the least variations in choice of materials, while apexofication

and regenerative endodontics revealed a wide range in concentration of irrigation

materials, especially sodium hypochlorite, intermadiate agents (mainly combinations

of antibiotics) and variations in obturation (with mainly MTA or Biodentine)

technique. Positive outcome was mainly defined by control rentgenography and

clinical examination.

Various endodontists‘ associations have different protocols of regenerative endodontics for

non-vital teeth pulp treatment with immature roots. For instance, American association of

endodontists (AAE) recommends at least two appointments‘ protocol, where 1.5% NaOCl is

used for irrigarion, calcium hydroxide paste or low concentration of triple antibiotic paste

(ciprofloxacin, metronidazole, minocycline) as intermediate agents and canal is obturated

with MTA above PRP or PRF or autologous fibrin matrix (AFM) and sealed with glass

ionomer cements. Sometimes bioceramics or tricalcium silicate cements are recommended

to substitute MTA for an esthetic concern [38].

Meanwhile, the European Society of Endodontology (ESE) advise several irrigators such as

1.5–3% sodium hypochlorite, later sterile physiological saline to minimize the cytotoxic

effects and 17% EDTA. Another difference than in AAE protocol is that only calcium

hydroxide is used between visits. Subsequently, during obturation procedure ESE recommend

to induce bleeding by mechanical irritation of periapical tissue, to wait for blood clot

formation for 15 min, to cover with a collagen matrix for avoiding formation of a hollow

space and ,finally, to place a hydraulic silicate cement (e.g. MTA or tricalcium silicate

cement) on top of the collagen matrix. Tooth should be restored with a glass–ionomer or

calcium hydroxide cement and adhesive restoration [39].

In this systematic review majority of authors used antibiotics pastes as an intermediate

agents, like AAE recommends.

In this systematic review any study compared results between two or more obturation

materials was not included, therefore it was impossible to compare the higher effectiveness of

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different materials. Some studies compared MTA effectiveness over Biodentine and found

that although MTA and biodentine as bioactive dental materials are successfully used for root

end closure of open apices, biodentine showed better initial healing while MTA had better

long-term effect [40]. Moreover, Kaur et al. concluded that MTA had same drawbacks such

as difficult manipulation, slow setting time and high cost and Biodentine has some advantages

like easier manipulation, low cost and faster setting is the major advantages of this material

when compared to MTA. Due to lack of long term observational studies, it is complicated to

distinguish which material MTA or Bio dentine is superior, however Biodentine is more

recommended for open apices then MTA [41].

The main limitations of this systematic review and that mainly only case reports were

included. Consequently, usually only susscesfull and favourable cases are published by

authors. No any study compared two different treatment methods was analysed in this

systematic review. Thus, it is not possible to state which treatment method or metarials used

for endodontics treatment for teeth with immature roots is the most proper.

CONCLUSION The most suitable treatment methods for Necrotic pulp or Apical chronic periodontitis when

the roots are not fully developed is apexofication or the newest methods- Regenerative

endodontics, the dental materials ware Ca(OH)2p, MTA or Biodentine . No differences were

found in the efficacy of the treatment. The success rate of all the materials is very high, and

even in some of the articles, 100% success rate.

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EVALUATION FORM OF THE MASTER’S THESIS FOR THE MEMBER OF DEFENCE COMMITTEE

Graduate student

___________________________________________________________________,

of the year ______, and the group _____ of the integrated study programme of Odontology

Master’s Thesis title: …………………............................………………….……………….....

…………

…………………………………………..................................….………………….....……......

No. MT evaluation aspects

Evaluation

YesPartiall

y No

1Has the student’s presentation lasted for more than 10 minutes?

2Has the student presented the main problem of the Master’s thesis, its aim and tasks?

3Has the student provided information on research methodology and main research instruments?

4Has the student presented the received results comprehensively?

5Have the visual aids been informative and easy to understand?

6 Has the logical sequence of report been observed?

7Have the conclusions been presented? Are they resulting from the results?

8 Have the practical recommendations been presented?

9 Have the questions of the reviewer and commission’s members been answered correctly and thoroughly?

10Is the Master’s thesis in compliance with the essence of the selected study programme?

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Remarks of the member of evaluation committee of Master’s Thesis ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Evaluation of the Master’s Thesis

_____________________________________________________________________________

Member of the MT evaluation committee:

________________ ___________________________ _____________________ (scientific degree) (name and surname) (signature)

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Protocol of systematic review

TITLE Permanent tooth pulp therapy in young permanent dentition (roots were not fully developed)in pediatrics as treatment option: a systematic review.

INTRODUCTIN

Rationale

Objectives/aim

Aim: To assess the most suitable treatment methods and used dental materials for pulp therapy when roots of teeth are not fully developed.

Objectives: - Analyzing recent clinical data and discussing different clinical key

factors that might alter or enhance success and survival rates of this treatment.

- To search and select the publications for analysis according to the conclusion and exclusion criteria.

- To identify the most proper treatment methods and dental materials used in cases of pulptherapy.

- To evaluate the efficacy of special dental materials which are used in such procedures.

METHODS

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Eligibilitycriteria

Information sources

Studyselection

Outcomes and prioritization

. PICOS: o P- Participants: Children needed pulptherapy for immature

permanent tooth o I- Intervention: partial pulpotomy, apexofication, regenerative

endodontics o C- Group of examined subjects: - immature permanent teeth

with deep caries lesions whit pulp involvement; o O- Success / Survival rate outcomes; o S- Study design selection: clinical trials and case reports

.

. Inclusion criteria: o Follow-up period >1 year. o Report characteristics: if was published over the last 10 years; o English language; o Full texts. o Study design: case report; clinical trials; o Studies performed on humans (in vivo)

.

. Exclusion criteria: o Non-full articles or inaccessible full articles unless purchased o Study design: systematic reviews o Studies mixing both children and adults, including only adults. o Lack of important data: follow-up period. o Studies in vitro, on animals, non-english, follow-up period less

than1years. o Studies in which traumatic teeth were pulp involvment.

. Electronic databases: Pubmed, ReasearchGate, Wiley Online Library.

. Keywords: dental/tooth, immature tooth, pulpotomy,apexogenesis, apexofication, regenerative endodontics, pediatric/child.

. Timeframe: June 2018 – December 2018.

. Identification phase by entering the keywords in different combinations and according inclusion criteria.

. Screening excluding duplicates;

. Eligibility according exclusion criteria: non-full texts, other study designs, articles about adult and pediatric patients, lack of relevant details.

. Double-checking articles that were included in systematic review by supervisor (Sandra Petrauskienė).

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pulp therapy in young permanent den- tition: a …

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