Vital pulp treatment for traumatized permanent teeth: A systematic review

Abstract

Background Traumatic dental injuries involving the pulp are quite common and there is a need to evaluate the quality of evidence on the success of vital pulp treatment (VPT) interventions in traumatised permanent teeth. Objectives The aim of this systematic review was to assess the success of VPT in the management of traumatised human vital permanent teeth diagnosed with complicated crown or crown‐root fractures. Methods An electronic search of the following databases: Web of Science, Scopus, PubMed, MEDLINE, EMBASE, LILACS, Clinical Trial Registries and the grey literature was performed until 25th/8/2021. Controlled clinical trials, cohort studies, case‐control studies, case series with at least five cases and a minimum of 12‐months follow‐up were included. Non‐English language literature was excluded. Two independent assessors performed study selection, data extraction and quality assessment using the National Institutes of Health’s quality assessment tool. Disagreements were resolved through consensus/with a third assessor. Results A total of 14‐studies (2‐controlled clinical trials, 1‐case‐control, and 11‐case series) published between 1978–2020, with a total of 1081 permanent teeth and an age range between 6–42 years‐old were included. Bias analysis ranged considerably from ‘good’ to ‘poor’. Meta‐analysis was not performed due to data heterogeneity, unclear reporting, and limited number of controlled clinical studies. Partial pulpotomy was the main reported clinical procedure with an overall success rate between 82.9–100%. Complete pulpotomy and direct pulp capping were associated with lower success rates of 79.4–85.7% and 19.5%, respectively. Calcium hydroxide was the main pulp capping material with favourable clinical and radiographic success (79.4–100%). Biodentine®, mineral trioxide aggregate and IRoot® BP were also associated with a high clinical and radiographic success, 80–91%, 80–100%, and 90–100%, respectively, albeit in fewer studies. Discussion Although a high success rate has been reported when using VPT in managing pulpally involved traumatised teeth, the results of this systematic review clearly highlighted a paucity and low quality of the available evidence. Conclusions Overall high success of VPT in the management of traumatised vital permanent teeth were reported, although based on limited evidence of well‐conducted clinical studies. Registration PROSPERO database (CRD42020205213).

Complicated Crown Fracture of Permanent Incisors: A Conservative Treatment Case Report and a Narrative Review

“…In general, VPT has a high success rate. However, clinical factors such as the vitality of the pulp, the time from exposure to intervention, age of the patient, other coexisting injuries, the cause of exposure, and the extent of exposure may influence the favorable outcome [ 11 ]. Additionally, PP has the advantage of preserving the cell-rich coronal pulp, which may provide greater healing potential, and so maintain the possibility of having physiological dentin deposition [ 12 ].…”

“…In the case of difficulties, tests based on the measurement of actual blood flow, such as LDF or pulse oximetry, are recommended [ 13 ]. The increasing time between injury and intervention contributes to lower treatment success [ 11 , 14 ]. The age of the patient, and, thus, root development, does not influence the treatment prognosis [ 11 ].…”

Pulpotomie beim bleibenden Zahn – Möglichkeiten und Grenzen

“…Bei Pulpaeröffnung durch einen Zahnunfall beträgt die Erfolgsrate der partiellen Pulpotomie bei bleibenden Zähnen mit unvollständigem Wurzelwachstum zwischen 90% und 100% und bei abgeschlossenem Wurzelwachstum zwischen 70% und 100% 7 . In Bezug auf die Prognose der partiellen Pulpotomie ist es unbedeutend, wie großflächig die Pulpa durch eine Kronenfraktur eröffnet wurde 18 . Die Erfolgssicherheit der partiellen Pulpotomie hängt auch nicht wesentlich davon ab, ob Kalziumsilikatzement oder Kalziumhydroxid als Überkappungsmaterial verwendet wird 18 .…”

“…In Bezug auf die Prognose der partiellen Pulpotomie ist es unbedeutend, wie großflächig die Pulpa durch eine Kronenfraktur eröffnet wurde 18 . Die Erfolgssicherheit der partiellen Pulpotomie hängt auch nicht wesentlich davon ab, ob Kalziumsilikatzement oder Kalziumhydroxid als Überkappungsmaterial verwendet wird 18 . Angesichts der hohen Erfolgsraten ist die Vitalerhaltung bei Kronenfrakturen mit Pulpaeröffnung unabhängig vom Alter des Patienten anzustreben.…”

“…Angesichts der hohen Erfolgsraten ist die Vitalerhaltung bei Kronenfrakturen mit Pulpaeröffnung unabhängig vom Alter des Patienten anzustreben. Begleitend auftretende Dislokationsverletzungen können den Erfolg allerdings einschränken 18 . Die adhäsive Abdeckung der Überkappungsmaterials und Versiegelung der Dentinwunde sollen möglichst im Rahmen der Primärversorgung stattfinden.…”