Comparison of Endoflas and Zinc Oxide Eugenol As Root Canal Filling Materials for Pulpectomy in Deciduous Teeth: a Systematic Review and Meta-Analysis

Overview

Journal Saudi Dent J

Specialty Dentistry

Date 2024 Jun 17

PMID 38883905

Authors

Riham Awad

Mazen Musa

Mohamed Elhoumed

Fei Liu

Qingyu Guo

Affiliations

Soon will be listed here.

Abstract

Objectives: To evaluate and compare the effectiveness of Endoflas and Zinc Oxide Eugenol (ZOE) as root canal filling materials (RCFMs) for the pulpectomy of deciduous teeth by analyzing multiple clinical and radiographic success and failure follow-ups in previously published studies.

Data: All clinical studies that investigated the pulpectomy of the deciduous teeth of children aged 3-9 years.

Sources: The databases used for source identification included MEDLINE (via PubMed), Scopus, Web of Science, and the Cochrane Library. No limitations were imposed on the publication year or language. The selection of studies and extraction of relevant study characteristics were conducted from December 26, 2021, to September 7, 2023. Additionally, the risk of bias (RoB) in the included studies was evaluated by using a RoB instrument (RoB 2). Eligible studies were then combined, and a random-effects model was applied by using the maximum likelihood estimations of log risk ratios and their corresponding 95% confidence intervals.

Study Selection: Of the 3913 records found in the abovementioned databases, nine were eligible for systematic review and eight were eligible for -analysis. The studies included 628 pulpectomies of deciduous molar teeth in children. The overall results showed that compared with Endoflas, ZOE was associated with a higher risk ratio for clinical evaluation (LOG[RR] = 0.06, CI 0.03-0.09, -value 0.001) and radiographic evaluation (LOG[RR] = 0.68, CI 0.35-1.00, -value 0.001). This association was highly significant at 6- and 9-month follow-ups.

Conclusion: Compared with ZOE, Endoflas was associated with a lower risk of the clinical and radiographic failure of deciduous teeth pulpectomy and a 6%-6.8% higher risk ratio, especially at 6- and 9-month follow-ups.

Clinical Significance: This study suggests the superiority of Endoflas over ZOE as an RCFM for deciduous teeth.

References

Garcia-Godoy F . Evaluation of an iodoform paste in root canal therapy for infected primary teeth. ASDC J Dent Child. 1987; 54(1):30-4. View

Rewal N, Thakur A, Sachdev V, Mahajan N . Comparison of endoflas and zinc oxide eugenol as root canal filling materials in primary dentition. J Indian Soc Pedod Prev Dent. 2014; 32(4):317-21. DOI: 10.4103/0970-4388.140958. View

RIFKIN A . A simple, effective, safe technique for the root canal treatment of abscessed primary teeth. ASDC J Dent Child. 1980; 47(6):435-41. View

Trairatvorakul C, Chunlasikaiwan S . Success of pulpectomy with zinc oxide-eugenol vs calcium hydroxide/iodoform paste in primary molars: a clinical study. Pediatr Dent. 2008; 30(4):303-8. View

Holan G, Fuks A . A comparison of pulpectomies using ZOE and KRI paste in primary molars: a retrospective study. Pediatr Dent. 1993; 15(6):403-7. View

Al-Ostwani A, Al-Monaqel B, Al-Tinawi M . A clinical and radiographic study of four different root canal fillings in primary molars. J Indian Soc Pedod Prev Dent. 2016; 34(1):55-9. DOI: 10.4103/0970-4388.175515. View

Tchaou W, Turng B, Minah G, Coll J . Inhibition of pure cultures of oral bacteria by root canal filling materials. Pediatr Dent. 1996; 18(7):444-9. View

Sterne J, Savovic J, Page M, Elbers R, Blencowe N, Boutron I . RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366:l4898. DOI: 10.1136/bmj.l4898. View

Brothwell D . Guidelines on the use of space maintainers following premature loss of primary teeth. J Can Dent Assoc. 1997; 63(10):753, 757-60, 764-6. View

10.

Subramaniam P, Gilhotra K . Endoflas, zinc oxide eugenol and metapex as root canal filling materials in primary molars--a comparative clinical study. J Clin Pediatr Dent. 2011; 35(4):365-9. DOI: 10.17796/jcpd.35.4.1377v06621143233. View

11.

Gupta S, Das G . Clinical and radiographic evaluation of zinc oxide eugenol and metapex in root canal treatment of primary teeth. J Indian Soc Pedod Prev Dent. 2011; 29(3):222-8. DOI: 10.4103/0970-4388.85829. View

12.

Barja-Fidalgo F, Moutinho-Ribeiro M, Oliveira M, Oliveira B . A systematic review of root canal filling materials for deciduous teeth: is there an alternative for zinc oxide-eugenol?. ISRN Dent. 2011; 2011:367318. PMC: 3169841. DOI: 10.5402/2011/367318. View

13.

Mortazavi M, Mesbahi M . Comparison of zinc oxide and eugenol, and Vitapex for root canal treatment of necrotic primary teeth. Int J Paediatr Dent. 2004; 14(6):417-24. DOI: 10.1111/j.1365-263X.2004.00544.x. View

14.

Mohammadi Z, Dummer P . Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J. 2011; 44(8):697-730. DOI: 10.1111/j.1365-2591.2011.01886.x. View

15.

Najjar R, Alamoudi N, El-Housseiny A, Al Tuwirqi A, Sabbagh H . A comparison of calcium hydroxide/iodoform paste and zinc oxide eugenol as root filling materials for pulpectomy in primary teeth: A systematic review and meta-analysis. Clin Exp Dent Res. 2019; 5(3):294-310. PMC: 6585588. DOI: 10.1002/cre2.173. View

16.

Coll J, Vargas K, Marghalani A, Chen C, AlShamali S, Dhar V . A Systematic Review and Meta-Analysis of Nonvital Pulp Therapy for Primary Teeth. Pediatr Dent. 2020; 42(4):256-461. View

17.

Songvejkasem M, Auychai P, Chankanka O, Songsiripradubboon S . Survival rate and associated factors affecting pulpectomy treatment outcome in primary teeth. Clin Exp Dent Res. 2021; 7(6):978-986. PMC: 8638319. DOI: 10.1002/cre2.473. View

18.

Primosch R, Glomb T, Jerrell R . Primary tooth pulp therapy as taught in predoctoral pediatric dental programs in the United States. Pediatr Dent. 1997; 19(2):118-22. View

19.

Guyatt G, Oxman A, Vist G, Kunz R, Falck-Ytter Y, Alonso-Coello P . GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008; 336(7650):924-6. PMC: 2335261. DOI: 10.1136/bmj.39489.470347.AD. View

20.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View