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

ArticleinJournal of endodontics 37(5):581-7 · May 2011with105 Reads
Impact Factor: 3.38 · DOI: 10.1016/j.joen.2010.12.004 · Source: PubMed
Abstract

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.

    • "... trial data. The success rates of direct pulp caps have been found to vary greatly between studies [1], which might be due to a large number of confounders affecting the results and most studies not ful..."
      Overall, we cannot deduct further clinical recommendations from the available controlled trial data. The success rates of direct pulp caps have been found to vary greatly between studies [1], which might be due to a large number of confounders affecting the results and most studies not fully reporting or controlling these confounders. Such variables include age (potentially better results in younger compared with older patients), the kind of exposure (better results for traumatic or artificial than carious exposure), the size of the exposure and the degree of bleeding of the pulp (better results for small exposures with swift hemostasis), the dentition (higher success in permanent than primary teeth), or the conditions (decreased efficacy in studies with unexperienced operators like students) [2, 12, 17].
    [Show abstract] [Hide abstract] ABSTRACT: Objectives We systematically assessed randomized controlled trials comparing direct pulp capping materials. Methods Trials comparing materials for direct capping and evaluating clinically and/or radiographically determined success after minimum 3 months were included. Two reviewers independently screened electronic databases (Medline, Central, Embase) and performed hand searches. Risk of bias was assessed and meta-analyses were performed, separated for dentition. Trial sequential analysis was used to assess risk of random errors. Strength of evidence was graded using the GRADE approach. Results From a total of 453 identified studies, 11 (all with high risk of bias) investigating 1094 teeth (922 patients) were included. Six studies were on primary teeth (all with carious exposures) and five on permanent teeth (carious and artificial exposures). Mean follow-up was 14 months (range 3–24). Most studies used calcium hydroxide as control, comparing it to mineral trioxide aggregate (MTA) (three studies), bonding without prior etching/conditioning (two), or bonding with prior etching/conditioning, enamel matrix proteins, resin-modified glass ionomer cement, calcium sulfate, zinc oxide eugenol, corticosteroids, antibiotics, or formocresol (each in only one study). One study compared MTA and calcium-enriched cement. In permanent teeth, risk of failure was significantly decreased if MTA instead of calcium hydroxide was used (risk ratio (RR) [95 % confidence intervals (CI)] 0.59 [0.39/0.90]); no difference was found for primary teeth. Other comparisons did not find significant differences or were supported by only one study. No firm evidence was reached according to trial sequential analysis. Conclusion There is insufficient data to recommend or refute the use of a specific material. More long-term practice-based studies with real-life exposures are required. Clinical relevance To reduce risk of failure, dentists might consider using MTA instead of calcium hydroxide (CH) for direct capping. Current evidence is insufficient for definitive recommendations.
    No preview · Article · Mar 2016 · Clinical Oral Investigations
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    • "...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/injur..."
      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.
    [Show abstract] [Hide abstract] ABSTRACT: Human dental pulp inflammation can progress to periapical lesion formation and conventional root canal treatment (RCT) has been the traditional method for disease management. This observational study presents two cases of vital pulp therapy in mature molars diagnosed with irreversible pulpitis and associated with apical periodontitis. In these two clinical cases, the involved teeth had deep carious lesions with a history of spontaneous/lingering pain and radiographic examinations revealed the presence of apical radiolucencies. A conservative miniature pulpotomy (MP) using calcium-enriched mixture (CEM) was performed and the teeth were permanently restored with amalgam. Clinical evaluations indicated resolution of pain 24 hours after treatment; the teeth showed normal vitality, remained asymptomatic and maintained normal function after recall examinations. Furthermore, the 18-month radiographic evaluation showed healing of the apical lesions. Vital pulp therapy using the MP technique with CEM appeared successful in avoiding RCT intervention. These two reports of case outcome suggest that simple MP using a CEM bioregenerative technique may provide a favorable outcome for permanent teeth diagnosed with irreversible pulpitis and associated with apical periodontitis.
    Full-text · Article · Jan 2016 · Iranian Endodontic Journal
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    • "...dence regarding the effect of age or status of root development on the outcome of VPT (Aguilar & Linsuwanont 2011). In a randomized clinical trial, age was not found to be a significant factor in the outcome of co..."
      Hard tissue barrier formation as detected radiographically has been reported in 10/26 young permanent teeth (Alqaderi et al. 2014) compared to 5/43 in this study; similarly, hard tissue barrier formation and pulp horn obliteration were found in 70% of 49 young permanent teeth treated with CH partial pulpotomy over 1-to 11-year followup (Mass & Zilberman 2011). Generally there is a little evidence regarding the effect of age or status of root development on the outcome of VPT (Aguilar & Linsuwanont 2011). In a randomized clinical trial, age was not found to be a significant factor in the outcome of complete pulpotomy using CEM in three age groups (<20, 20–29, and ≥30 years) (Asgary et al. 2015).
    [Show abstract] [Hide abstract] ABSTRACT: Aim: To assess the outcome of mineral trioxide aggregate (MTA) complete pulpotomy in permanent teeth with carious exposures. Methodology: Fifty-two permanent molar teeth with fully developed roots and vital pulps in 43 patients aged 11-51 years were included. Preoperative pulpal and periapical diagnosis was established. After informed consent each tooth was anaesthetized, isolated with dental dam and disinfected with 5% NaOCl before caries excavation; subsequently a full pulpotomy was performed. Haemostasis was achieved and Grey MTA (Angelus, Londrina, Brazil) was placed as the pulpotomy agent; a moist cotton pellet was placed and the tooth was temporized with intermediate restorative material (IRM). Permanent restorations were placed one week later if the tooth was asymptomatic, and a postoperative periapical radiograph was taken. Clinical and radiographic evaluation was completed at 3 months, 6 months, 1 year and 3 years postoperatively. Results: Clinical signs and symptoms suggestive of irreversible pulpitis were established in 44/52 teeth, and periapical rarefaction was present in 14 teeth. Immediate failure occurred in one tooth. Recall rate ranged from 92% at 3 months to 80.3% at 3 years, with an overall 100% clinical and 97.5% radiographic success during the first year, and 92.7% success at 3 years. All cases with periapical rarefaction were associated with improvement in the periapical index (PAI) score. Two cases had new periapical rarefaction due to dislodgment of the permanent restoration. A hard tissue barrier was detected radiographically in 5 cases and canal narrowing in 7 cases. Conclusion: MTA full pulpotomy was a successful treatment option for cariously exposed pulps in mature permanent molar teeth This article is protected by copyright. All rights reserved.
    Full-text · Article · Dec 2015 · International Endodontic Journal
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