Vital Pulp Therapy in Vital Permanent Teeth with Cariously Exposed Pulp: A Systematic Review

Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
Journal of endodontics (Impact Factor: 3.38). 05/2011; 37(5):581-7. DOI: 10.1016/j.joen.2010.12.004
Source: PubMed


This systematic review aims to illustrate the outcome of vital pulp therapy, namely direct pulp capping, partial pulpotomy, and full pulpotomy, in vital permanent teeth with cariously exposed pulp.
Electronic database MEDLINE via Ovid, PubMed, and Cochrane databases were searched. Hand searching was performed through reference lists of endodontic textbooks, endodontic-related journals, and relevant articles from electronic searching. The random effect method of weighted pooled success rate of each treatment and the 95% confidence interval were calculated by the DerSimonian-Laird method. The weighted pooled success rate of each treatment was estimated in 4 groups: >6 months-1 year, >1-2 years, >2-3 years, and >3 years. All statistics were performed by STATA version 10. The indirect comparison of success rates for 4 follow-up periods and the indirect comparison of clinical factors influencing the success rate of each treatment were performed by z test for proportion (P < .05).
Overall, the success rate was in the range of 72.9%-99.4%. The fluctuation of the success rate of direct pulp capping was observed (>6 months-1 year, 87.5%; >1-2 years, 95.4%; >2-3 years, 87.7%; and >3 years, 72.9%). Partial pulpotomy and full pulpotomy sustained a high success rate up to more than 3 years (partial pulpotomy: >6 months-1 year, 97.6%; >1-2 years, 97.5%; >2-3 years, 97.6%; and >3 years, 99.4%; full pulpotomy: >6 months-1 year, 94%; >1-2 years, 94.9%; >2-3 years, 96.9%; and >3 years, 99.3%).
Vital permanent teeth with cariously exposed pulp can be treated successfully with vital pulp therapy. Current best evidence provides inconclusive information regarding factors influencing treatment outcome, and this emphasizes the need for further observational studies of high quality.

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    • "Die Autoren haben einen solchen Vergleich unter Nutzung der präsentierten Studiendaten mittels eines Simulationsmodells unternommen und kamen zu dem Schluss, dass durch die reduzierte Chance einer Pulpaexposition nach einzeitigunvollständigem im Vergleich mit einem vollständigen Vorgehen Zähne signifikant länger erhalten werden könnten [1]. Dafür sind wahrscheinlich die oftmals nur begrenzt erfolgreichen Therapien nach Pulpaexposition verantwortlich [12]. Eine Schwäche dieser Studie ist ein Mangel an Subgruppen-und Sensitivitätsanalysen. "

    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 03/2015; 109(1). DOI:10.1016/j.zefq.2015.01.009
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    • "This is not the mentioned issue in many previous studies, especially for age [1] [4] [19] [20] [22]. Moreover, according to a recent systematic review, VPT should be considered as an alternative treatment to pulpectomy in vital permanent teeth with carious pulp exposure, and partial/full pulpotomy is more predictable than DPC [6]. The last but not least is the undeniable role of tooth restoration and sealing which can imply support for the ongoing healing in the pulp by providing a bacteria-free environment [48]. "
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    ABSTRACT: In modern endodontics, vital pulp therapy (VPT) has been considered an ultra-conservative treatment modality. Based on the level of pulp preservation, VPT includes stepwise excavation, indirect pulp capping (IDPC), direct pulp capping (DPC), miniature pulpotomy (MP), partial/Cvek pulpotomy and coronal/complete pulpotomy (CP). The present article reviews the treatment outcomes of 94 permanent teeth with irreversible pulpitis treated with either IDPC (n=28), DPC (n=28), MP (n=29) or CP (n=9) using calcium-enriched mixture (CEM) cement. After a mean follow-up time of 12.3 months, 93 treated teeth were radiographic/clinically successful; only one radiographic failure was observed in the DPC group.
    Iranian Endodontic Journal 10/2014; 9(4):295-300.
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    • "It puts an emphasis the high healing capacity of pulp tissue in both young and old patients after the removal of the etiologic factors. It is likely that the complete removal of the inflamed pulp rather than the status of the root apex is the critical point; recent evidence indicates that VPT could also be performed successfully in old patients [3]. Dentists are traditionally taught that when a patient complains of spontaneous pain or prolonged pain upon cold stimulus, the diagnosis would be irreversible pulpitis and complex expensive pulpectomy is indicated. "
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    ABSTRACT: Vitality of dental pulp is essential for long-term tooth survival. The aim of vital pulp therapy is to maintain healthy pulp tissue by eliminating bacteria from the dentin-pulp complex. There are several different treatment options for vital pulp therapy in extensively decayed or traumatized teeth. Pulp capping or pulpotomy procedures rely upon an accurate assessment of the pulp status, and careful management of the remaining pulp tissue. The purpose of this review is to provide an overview of new approaches in vital pulp therapy in permanent teeth.
    Iranian Endodontic Journal 01/2014; 9(1):15-22.
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