Dataset Information

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.

Conclusion

Within the limitations of this review, the benefits and high success rates reported for partial pulpotomy suggest this procedure, rather than pulp-capping, should be considered as the treatment of choice for both immature and mature teeth that have suffered complicated crown-fractures.

SUBMITTER: Donnelly A

PROVIDER: S-EPMC9304243 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Treatment planning is key to clinical success. Permanent teeth diagnosed with "irreversible pulpitis" have long been implied to have an irreversibly damaged dental pulp that is beyond repair and warranting root canal treatment. However, newer clinical approaches such as pulpotomy, a minimally invasive and biologically based procedure have re-emerged to manage teeth with pulpitis. The primary aim of the study was to conduct a meta-analysis to comprehensively estimate the overall success rate of pulpotomy in permanent teeth with irreversible pulpitis as a result of carious pulp exposure. The secondary aim of the study was to investigate the effect of predictors such as symptoms, root apex development (closed versus open), and type of pulp capping material on the success rate of pulpotomy. Articles were searched using PubMed, Scopus, CENTRAL, and Web of Science databases, until January 2021. Outcomes were calculated by pooling the success rates with a random effect model. Comparison between the different subgroups was conducted using the z statistic test for proportion with significance set at alpha = 0.05. A total of 1,116 records were retrieved and 11 studies were included in the quantitative analysis. The pooled success rate for pulpotomy in teeth with irreversible pulpitis was 86% [95% CI: 0.76-0.92; I2 = 81.9%]. Additionally, prognostic indicators of success were evaluated. Stratification of teeth based on (1) symptoms demonstrated that teeth with symptomatic and asymptomatic irreversible pulpitis demonstrated success rate of 84% and 91% respectively, with no significant difference (p = 0.18) using z-score analysis; (2) open apex teeth demonstrated a significantly greater success rate (96%) compared to teeth with closed apex (83%) (p = 0.02), and (3) pulp capping materials demonstrated that Biodentine yielded significantly better success rates compared to Mineral Trioxide Aggregate (MTA), calcium hydroxide, and Calcium Enriched Mixture (CEM.) Collectively, this is the first meta-analytical study to determine the clinical outcome of pulpotomy for carious teeth with irreversible pulpitis and it's predictors for success. Moreover, we identify the stage of root development and type of biomaterial as predictors for success of pulpotomy.

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