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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    • "In the new millennium, the ultimate goal of endodontology should be to reinstate the diseased or necrotic human dental pulp to a normal state of health and function[5]without complex intervention i.e. root canal therapy (RCT)[6]. Vital pulp therapy (VPT) is a simple, biologic, regenerative, conservative and economic method that shows a favorable success rate; treatment includes direct/indirect pulp capping and miniature/partial/complete pulpotomy using various pulp capping agents[7,8]. Miniature pulpotomy (MP) is a procedure that requires minimal removal of the infected dentin/injured pulp tissue not exceeding 1 mm at the exposure site. "

    Full-text · Article · Jan 2016 · Iranian Endodontic Journal
    • "A recent systematic review has assessed several different methods of vital pulp therapies for mature and immature teeth such as direct pulp capping, partial pulpotomy, and coronal pulpotomy [5]. However, in that review [5], the included studies had different treatment therapies, inconsistent definition of success rate, the follow-up periods were pooled, as well as several duplicate articles were included in the review. The objective of the present systematic review is to specifically assess the success rate of coronal pulpotomy in treating carious vital pulp exposure in permanent posterior teeth with closed root apices in order to evaluate a potential alternative when RCT cannot be performed. "
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    ABSTRACT: Objectives This systematic review was performed to evaluate the clinical outcome of coronal pulpotomy treatment to manage carious vital pulp exposure in permanent posterior teeth with closed root apices. Data/Sources PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used. A search of articles published between 1960 January and 2015 July was conducted in PubMed, EMBASE, and CENTRAL databases. Study selection Only studies that performed full coronal pulpotomy for carious vital pulp exposure of permanent posterior teeth and had clinical and radiographic assessments during at least one-year follow-up were qualified for data analyses. The weighted mean success rate (WSR) was the primary outcome and estimated using DerSimonian-Laird random effects model. Out of 299 articles, six studies were included for the analysis of one-year WSR, and five studies were included in the analysis of two-year WSR. The one-year and two-year WSR were 94% (95% confidence interval (CI): [90,99]) and 92% (CI: [84,100]) respectively. Differences in pulp capping and restoration materials did not significantly affect success rates (Two-year WSR in the MTA and MTA-like products group vs. the calcium hydroxide group: 92% (CI: [85,99]) vs. 88% (CI: [76,100]); the amalgam group vs. the composite group: 92% (CI: [81,100]) vs. 93% (CI: [81,100])). Conclusions Generally, full coronal pulpotomy had a favorable success rate in treating carious vital pulp exposure of permanent mature teeth with closed root apices. More studies with control group of root canal treated teeth and longer follow-up periods are needed. Clinical significance Coronal pulpotomy treatment can be considered as an intermediate treatment option in managing carious vital pulp exposures of permanent teeth with closed root apices. This option may also serve as a substitute to extraction when root canal treatment cannot be performed for low income and uninsured patients or in underserved areas.
    No preview · Article · Dec 2015 · Journal of dentistry
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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. "

    Full-text · Article · Mar 2015 · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen
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