Evidence-based Assessment: Evaluation of the Formocresol Vs. Ferric Sulfate Primary Molar Pulpotomy

Resident: Cho

Author(s): Loh et al.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2004. 26. 401-409.

Major topic: Evidence-based practice

Minor topic: Pulpotomy, Primary Molar, Formocresol, Ferric Sulfate

Type of Article: Scientific Article

Main Purpose:

Evidence-based practice (EBP) is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”

Research using EBP uses 5 steps: define the clinical research question, search all available literature for evidence, select studies for possible inclusion, appraise and rank the evidence in the selected studies and establish a final set of selected studies, compile and analyze date from the studies to produce a statistically based conclusion.

The aims of this study were to use EBP to examine the relative efficacy of formocresol (FC) and ferric sulfate (FS) as pulpotomy medicaments in primary teeth and produce recommendations on medicament selection for clinicians.

Overview of method of research:

EBP was used to conduct the research. Initially data was pulled using 6 search engines: Medline Ovid Library, Cochrane Library, PubMed, EMBASE, Science Citation Index, and System for Information on Grey Literature in Europe. The literature was limited to studies addressing FC and/or FS, related to pulpotomy, and performed on primary deciduous teeth. In a secondary sieve, the search was limited to actual experiments and studies that lasted for up to the exfoliation of primary molar teeth. The studies were ranked by hierarchy of evidence.

In the end, 13 studies (3 randomized clinical trials and 10 clinical trials) were analyzed statistically using meta-analysis. 1 randomized clinical trial and 1 clinical trail were analyzed by the direct technique, and all 13 trials were analyzed by the indirect technique.

Findings:

Clinical and radiographic data from the indirect technique and radiographic data from the direct technique shows no significant difference between FC and FS, although FS trended toward higher clinical success. FS cannot be concluded to be the superior medicament because only 2 trials were included in the direct technique, which indicates low statistical power and possible skewing. Also, P values observed exceeded 0.05 suggesting inadequate evidence to conclude that FS is more successful than FC. In addition, follow-up times differed between the two studies (20 months vs. 35 months).

Key points/Summary:

EBP concludes that human carious primary molars with reversible coronal pulpitis can be treated with pulpotomy using either ferric sulfate or formocresol and obtain similar clinical and radiographic success.

Assessment of Article:

The results of the study concluded that more prospective random clinical trials should be conducted in order to compare FC vs. FS in primary molar pulpotomies. This article focused more on EBP rather than FC vs. FS and was analyzing data from a limited number of studies. This article could be of value for aiding in how to formulate a clinical research question and research in general.