Sodium Hypochlorite Pulpotomy in Primary Teeth: A Systematic Review and Network Meta-Analysis

Objective: To investigate the clinical and radiographic success of pulpotomy in primary teeth with sodium hypochlorite (NaOCl) compared with other materials such as formocresol, ferric sulfate, MTA, saline solution, and diode laser. Material and Methods: Clinical trials and cohort studies were included. Seven electronic databases and gray literature were searched by November 2023 without restrictions of language, year of publication, or sample size. For quality assessment, Rob-2, ROBINS-I, and Newcastle-Ottawa Scale were used. Network meta-analyses were conducted. Direct-comparison heterogeneity was assessed with I2. Indirect-comparison heterogeneity was also evaluated. The certainty of the evidence was evaluated using the GRADE approach. Results: Sixteen studies were eligible and 13 studies were included in the network meta-analyses. There was no significant difference between pulpotomy with NaOCl and pulpotomy with formocresol, ferric sulfate, MTA, saline solution, and diode laser in clinical and radiographic outcomes at 6, 12, and 18 months. For most direct comparisons, I2 = 0%. Indirect-comparison heterogeneity ranged from low to considerable. Most clinical trials had moderate or high risk of bias. Cohort studies had low risk of bias. The certainty of the evidence was very low. Conclusion: There is no difference between NaOCl and other materials. The certainty of evidence is very low.