Evaluation of the effectiveness of a modified method for treating chronic pulpitis of evidence-based medicine

AIM. The aim of the study was to evaluate the effectiveness of the modified method of treating chronic pulpitis taking into account unfavorable outcomes from the standpoint of evidence-based medicine.

MATERIALS AND METHODS. Were examined 126 patients aged 20 to 60 years with a confirmed diagnosis of chronic fibrous pulpitis (K04.03) using evidence-based medicine criteria (ARR, RRR, NNT, OR) to evaluate the effectiveness of treating chronic pulpitis using a modified method developed by the authors in comparison with the standard treatment method. These were calculated based on outcome indicators: the primary endpoint was tooth extraction, the secondary endpoint was retreatment of endodontic therapy, and the surrogate endpoint was the presence of radiographic changes in the absence of clinical signs. Post-hoc comparisons were performed using the Pearson χ² test with Holm’s correction. Differences were considered statistically significant at p < 0.05.

RESULTS. With the modified treatment method, no cases of tooth extraction were detected (χ² = 5.87, df = 1, р = 0.015), the absolute risk reduction (ARR) was 4.9%, and the number of teeth that need to be treated to prevent 1 tooth extraction – NNT = 20. A shift from 1 OR value to the left determines a significant positive dynamic of the risk of tooth extraction in the modified treatment group. The results of the comparison for the secondary endpoint showed that the percentage of complications with the modified treatment method is three times lower than with the standard one: 2.5% versus 7.3%, respectively (χ² = 2.56, df = 1, р = 0.109). The difference in the frequency of this complication (ARR) is 4.8%, and the number of teeth that need to be treated to prevent 1 repeated endodontic treatment is 21 cases (NNT = 20). A leftward shift of the OR value from 1 indicates a moderate decrease in the risk of endodontic retreatment in the study group. A surrogate assessment revealed that the percentage of radiographic changes observed with the new treatment method was in three times lower than with standard treatment: 1.7% versus 4.9%, respectively (χ² = 1.69, df = 1, p = 0.194). The difference in these proportions (ARR) was 3.2%, and the number of teeth needed to treat to prevent one case of radiographic changes (NNT) was 31. A leftward shift of the OR value from 1 indicates that has been identified a tendency to decrease risk of occurrence the radiographic changes in the study group.

CONCLUSIONS. The obtained data indicate the clinical prospects of the modified treatment method and need for further research with an expanded sample.

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