Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: a systematic review and meta‐analysis

Abstract

Background The outcome of vital pulp treatment after carious pulp exposure is multifactorial and related to the procedure, biomaterial and pre‐operative pulpal diagnosis. Objectives To conduct a systematic review and meta‐analysis determining the outcome of direct pulp capping (DPC) in mature permanent teeth with a cariously exposed pulp and a clinical diagnosis of reversible pulpitis, and ascertain whether the capping material influences the outcome. Methods Sources: MEDLINE Ovid‐SP, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Embase and Web of Science until April 2020. Inclusion: Prospective, retrospective cohort studies and randomized trials investigating DPC outcome or comparing different capping materials after carious pulp exposure. Exclusion: Primary teeth, mechanical, traumatic or not specified pulp exposure, teeth with irreversible pulpitis or no pulpal diagnosis. Risk of bias assessed using Cochrane and modified Downs and Black quality assessment checklist. Meta‐analysis on combined clinical/radiographic outcome was performed using a random effect model. Success was defined as absence of signs and symptoms of irreversible pulpitis, apical periodontitis or loss of pulp vitality. Results Quality assessment highlighted four non‐randomized studies to be of fair and five of poor quality. Four randomized trials had a high risk of bias. The pooled success rate differed based on material and follow‐up. Calcium hydroxide success rate was 74% at 6‐months, 65% at 1‐year, 59% at 2–3 years and 56% at 4–5 years. Mineral trioxide aggregate (MTA) success was 91%, 86%, 84% and 81% at the same time points. Biodentine success was 96% at 6‐months, 86% at 1 year and 86% at 2–3 years. The meta‐analysis revealed MTA had better success than calcium hydroxide at 1‐year (OR 2.66, 95% CI; 1.46‐ 4.84, P = 0.001) and 2‐ to 3‐year follow‐up (OR 2.21, 95% CI; 1.42–3.44, P = 0.0004). There was no difference between MTA and Biodentine. Discussion These results were based on poor methodological quality studies. The effect size for of MTA vs Ca(OH)2, although modest, was consistent with narrow CI. Conclusions Low‐quality evidence suggests a high success rate for direct pulp capping in teeth with cariously exposed pulps with better long‐term outcomes for MTA and Biodentine compared with calcium hydroxide.

Deciphering Reparative Processes in the Inflamed Dental Pulp

“…VPTs such as pulp capping and pulpotomy procedures are indicated for managing cariously exposed pulps (5). Direct pulp capping is generally highly successful in noninfected traumatic exposure ( 83), but recent data showed high success rate for direct pulp capping of cariously exposed pulp using calcium silicate cements (84). These materials have a direct anti-bacterial action as well as tight sealing properties to prevent microleakage and subsequent infection.…”

Outcome measures to assess the effectiveness of endodontic treatment for pulpitis and apical periodontitis for use in the development of European Society of Endodontology (ESE) S3 level clinical practice guidelines: a protocol

“…Currently, a COS is not available within Endodontics. The lack of such standardized outcomes is reflected in the conclusions and quality of several systematic reviews reporting outcomes after root canal treatment (Ng et al 2007) and vital pulp treatment (VPT) (Cushley et al 2020) and is acknowledged in the recent ESE position statement addressing the management of deep caries and the exposed pulp (ESE 2019).…”

“…2007) and vital pulp treatment (VPT) (Cushley et al . 2020) and is acknowledged in the recent ESE position statement addressing the management of deep caries and the exposed pulp (ESE 2019).…”

Nanoparticles of Bioactive Glass Enhance Biodentine Bioactivity on Dental Pulp Stem Cells

“…In the 1990s, mineral trioxide aggregate (MTA) appeared, a calcium silicate-based cement (CSC) commercially available as ProRoot MTA (Tulsa Dental Products, Tulsa, OK, USA), Materials 2021, 14, 2684 2 of 12 composed mainly of Portland cement and bismuth oxide [13,14]. MTA has proven excellent biocompatibility, with the ability to induce mineralization, showing high clinical success rates for VPT, generally inducing bridge formation [7,11,15,16]. However, its long setting time [17], tooth discoloration [18], high cost and difficult handling characteristics are considered its main disadvantages [8,11].…”