Pulpotomy for treatment of complicated crown fractures in permanent teeth: A systematic review

Abstract

Background: Consensus on the treatment of choice for complicated crown fractures of teeth is limited. Recent guidance recommends vital-pulp-therapy; however, the preferred type is not specified. Higher success rates for pulpotomy compared to pulp-capping have been documented, which suggests pulpotomy may be a preferable option for complicated crown-fractures. Objectives:The purpose of this systematic review was to determine the success rate of pulpotomy (partial and complete) on teeth that suffered complicated crown fractures. Participants: patients who have suffered a complicated crown fracture to an anterior permanent tooth. Intervention: pulpotomy (partial or complete). Comparator: pulp-capping or root canal treatment. Outcome: combined clinical and radiographic success at or after 12 months.Methods: A systematic literature using key search terms was conducted using PubMed, Web of Science and Cochrane-Central-Register-of-Controlled-Trials (CENTRAL) as well as a grey literature search from inception to May 2021 and without language restricted to English. Strict inclusion criteria were applied. A standardized tool with defined criteria to assess the risk of bias in each study was used. For non-randomized comparative trials, the Robins-I tool was used while the Newcastle-Ottawa scale was used for non-comparative non-randomized studies. Results:Seven retrospective clinical studies were included. The studies reported high success rates for pulpotomy with overall success ranges for partial or complete pulpotomy ranging from 75% to 96%. One study compared the success rates of pulpotomy to an alternative treatment option pulp capping (90.9% vs. 67%, respectively).Due to the lack of homogeneity in the included studies, a meta-analysis was not possible.Discussion: This review highlights the limited evidence based for the current guidance on treatment of complicated crown fractures. The findings of the review indicate high success rates for pulpotomy; however, there is a moderate risk of bias and small sample sizes in the included studies with the result that the overall results should be interpreted with caution.

[Retracted] The Understanding of Vital Pulp Therapy in Permanent Teeth: A New Perspective

“…Therefore, in terms of histology, partial pulpotomy has the least impact on the development of young permanent teeth, and the prognosis is better. Relevant clinical studies have also confirmed this [29][30][31][32]. Related research on bioceramic materials is also available, whereby most studies show the excellent prospects of new bioceramic materials in pulpotomy treatment [33][34][35][36][37].…”

Factors that influence the outcome of pulpotomy in permanent teeth

“…Although a range of prognostic factors has been reported to affect the outcome of VPT including; age, preoperative pulpal status (Al‐Hiyasat et al, 2006), pulp capping material (Hilton et al, 2013), patient gender and pulpal lavage (Ballal et al, 2022), there remains a paucity of comparative evidence on which to base the true influence of these factors on outcome (Jakovljevic et al, 2022). Recent systemic reviews ( Tables 2 and 3 ) including a range of study types (Donnelly et al, 2022; Elmsmari et al, 2019) and other reviews limited to comparative evidence (Jakovljevic et al, 2022) have highlighted only a handful of studies on which to base clinical decision‐making in VPT. This review will analyse a range of prognostic factors and conclude with recommendations as to the strength of the evidence to support its effect.…”

“…VPT also includes conservative management techniques if the pulp is exposed by trauma, mechanically or by caries, such as pulp capping and partial and full pulpotomy (ESE, 2006(ESE, , 2019. According to the European Society of Endodontology (ESE, 2019), a full, coronal or complete pulpotomy involves the 'complete removal of the coronal pulp and the application of a biomaterial onto the pulp tissue at the level of the root canal orifice(s)', whilst a partial pulpotomy, also known as a 'Cvek pulpotomy' conducted after the pulp is traumatically exposed (Cvek, 1978;Donnelly et al, 2022;Mejare & Cvek, 1993), involves removal of a small portion of coronal pulp tissue after exposure followed by application of a biomaterial directly onto the remaining pulp tissue (ESE, 2019). After pulpotomy to remove diseased pulp tissue and biomaterial placement, the tooth should be permanently restored as quickly as possible to protect it from additional injury and infection and to promote healing and repair of remaining vital pulp tissue (ESE, 2006(ESE, , 2019.…”

Terapia Pulpar Vital en Diente con Fractura Coronaria Complicada

“…Una reciente revisión sistemática reportó buenos resultados tanto para la pulpotomía parcial y completa en dientes con desarrollo radicular completo eincompleto que han sufrido fracturas coronarias, estableciendo una tasa de éxito global que oscila entre 75% a 96,7% con un período de seguimiento mínimo de 12 meses (Donnelly et al, 2022). Sin embar-go, también demuestra la necesidad de ensayos clínicos controlados aleatorios, bien diseñados, con poder estadístico adecuado y con seguimiento prolongado que permitan demostrar el éxito a largo plazo de esta terapia (Donnelly et al, 2022).…”

“…Una reciente revisión sistemática reportó buenos resultados tanto para la pulpotomía parcial y completa en dientes con desarrollo radicular completo eincompleto que han sufrido fracturas coronarias, estableciendo una tasa de éxito global que oscila entre 75% a 96,7% con un período de seguimiento mínimo de 12 meses (Donnelly et al, 2022). Sin embar-go, también demuestra la necesidad de ensayos clínicos controlados aleatorios, bien diseñados, con poder estadístico adecuado y con seguimiento prolongado que permitan demostrar el éxito a largo plazo de esta terapia (Donnelly et al, 2022). El presente reporte de caso, si bien entrega información de un bajo nivel de evidencia en cuanto al tipo de estudio, se espera sirva como una importante herramienta educativa al comentar en detalle el procedimiento de una pulpotomía de Cvek, junto a los aspectos claves a considerar al realizar el seguimiento en estos pacientes.…”