Outcome of Partial Pulpotomy in Cariously Exposed Posterior Permanent Teeth: A Systematic Review and Meta-analysis

Abstract

Introduction: The current systematic review and meta-analysis aimed to evaluate the success rate of partial pulpotomy in treating permanent posterior teeth with carious vital pulp exposure. A secondary aim was to assess the prognostic factors using a meta-regression. Methods: An electronic search was performed for studies from January 1950 to November 2018 in the following databases: PubMed, ScienceDirect, and Cochrane. All searches were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies evaluating the success rate of cariously exposed vital human permanent posterior teeth treated with a partial pulpotomy were selected. Only randomized clinical trials and prospective clinical studies were included for evaluation. The Newcastle-Ottawa Scale and the Cochrane Collaboration's tool were used to evaluate risk assessment. Results: From the 218 studies identified through the initial search, 11 studies qualified for the final analysis (5 randomized clinical trials and 6 prospective studies). The results of the meta-analysis indicate a success rate of 98% (confidence interval [CI]: 0.94-1), 96% (CI: 0.92-0.99), and 92% (CI: 0.83-0.97) after 6 months and 1 and 2 years of follow-up. Examining the probable prognostic factors using meta-regression analysis, only preoperative pulp status (P 5 .001) was identified as a significant factor, with studies including teeth with the presumptive diagnosis of irreversible pulpitis displaying significantly lower results. The final solution, pulp capping material, apex closure, and the age of the patient did not affect the treatment success rate (P . .05). Conclusions: The available data suggest that a partial pulpotomy results in high success rates in treating cariously exposed permanent posterior teeth up to 2 years. Six months of monitoring can be considered an appropriate period when evaluating the success of a partial pulpotomy although more clinical and radiographic controls are essential to ensuring success.

Clinical Perspectives of Pulp Regeneration

“…The classic/conventional treatment methods for pulp exposure without loss of vitality are pulp capping or partial pulpotomy (amputation of 2-3 mm of the coronal pulp) 36 . The latter is often performed when there is not enough space for the capping material (ongoing preparation, present restauration, or fragment reattachment) or if the dental pulp is considered to be partially affected 36 . In the past, calcium hydroxide pastes were used, but recently developed HCSCs show better clinical results 36,37 .…”

“…The latter is often performed when there is not enough space for the capping material (ongoing preparation, present restauration, or fragment reattachment) or if the dental pulp is considered to be partially affected 36 . In the past, calcium hydroxide pastes were used, but recently developed HCSCs show better clinical results 36,37 . Here, we concentrate on the partial pulpotomy.…”

“…Direct pulp capping is associated with very high success rates (93%-100%) after artificial and mechanical exposure 68 , and in all other cases, the 5-year success rate with calcium hydroxide pastes in permanent teeth was about 59%-69%, and for HCSC, it was 78%-98% 68 . For partial pulpotomy, high success rates have been observed independent of age 36 , but other studies have reported less successful outcomes in mature teeth 38 .…”

Endodontic regeneration: hard shell, soft core

“…Whereas the pulp tissue as a whole was considered to be either reversibly or irreversibly damaged based on clinical criteria in the past, modern therapy approaches recommend amputation of locally highly inflamed areas based on intraoperative criteria like color and bleeding [24,47,52]. The amputation of pulp parts or the entire crown pulp (partial or total pulpotomy) can, thus, facilitate healing of the residual tissue even in cases of supposedly irreversibly damaged conditions [53][54][55].…”

Genetic and Epigenetic Characterization of Pulpal and Periapical Inflammation

“…Traditionally, carious pulp exposure was deemed a sign of irreversible pulp pathosis, regardless of symptoms. However, in the last decade, vital pulp therapy procedures have gained considerable popularity, with the realization that a carious pulp exposure does not automatically denote irreversible pulpitis (Bogen et al, 2008), that the pain from symptomatic pulpitis can be effectively managed with pulpotomy procedures (Eren et al, 2017;Galani et al, 2017), and that tricalcium silicates are effective materials for preserving the long-term vitality of the pulp (Schwendicke et al, 2016;Elmsmari et al, 2019;Li et al, 2019).…”