Diagnostic and Prognostic Predictors for the Success of Pulpotomy in Permanent Mature Posterior Teeth with Moderate to Severe Pulpitis: A Scoping Review

Abstract

A partial or complete pulpotomy is a type of vital pulp therapy (VPT) that aims to remove the inflamed, infected pulp, leaving behind healthy, vital pulp that is capable of healing. VPT has gained renewed popularity as a treatment option in permanent mature posterior teeth with irreversible, moderate to severe pulpitis; its high success rates matching that of root canal treatment (RCT). There is currently no consensus regarding diagnostic and prognostic predictors of success of pulpotomies for managing such cases. Therefore, we conducted a scoping review to identify and analyze how these factors affect the outcome of treatment. A literature search using the PRISMA guidelines was undertaken using PubMed and Scopus on 7 July 2023. A total of 22 studies met the inclusion criteria and were qualitatively analyzed by two reviewers. The following diagnostic and prognostic factors were recognized and discussed; presenting signs and symptoms, periapical diagnosis, bleeding time, indicators of inflammation (bleeding time, concentration of inflammatory biomarkers), patient age and medical status, the depth, activity and location of caries, and restorative factors. Based on the studies assessed, there is limited evidence to support their prognostic value. Further research is necessary to identify solid predictors of outcome.

Vital pulp therapy—Factors influencing decision‐making for permanent mature teeth with irreversible pulpitis: A systematic review

“…Conveying the latest knowledge to general dentists and specialist is critical to be able to provide this minimally invasive treatment modality to all patients when appropriate. Furthermore, there should be a heightened focus on potential prognostic factors as they play a crucial role in decision-making such as patient's overall health, tooth type, periapical status, symptoms features and restorability (Bjørndal et al, 2007;McHugh et al, 2023). Additionally, future studies should encompass all existing dentist-related and patient-related factors that influence the decision-making in treatment of irreversible pulpitis.…”