All treatment modalities for pulpotomy equally effective for deep caries in immature permanent teeth

Preservation of pulpal vitality in immature permanent teeth with deep carious lesions is essential to enable further root development and apical closure. This systematic review aimed to evaluate the evidence regarding the efficacy presented in clinical and radiographic success and bacteriological outcomes of techniques and materials used for deep caries management in vital immature permanent teeth.

Randomised controlled trials evaluating Vital Pulp Therapy (VPT) for deep caries in immature permanent posterior teeth without a history of irreversible pulpitis, and a follow-up period of ≥12 months were included. Study characteristics and outcomes of all included studies were summarized. Cochrane's Risk-of-bias tool 2.0 was used to assess the quality of eligible studies. Meta-analyses using a random effects model were performed. Electronic databases PubMed, Medline, Embase, LILACS, CENTRAL and Cochrane Library were searched, followed by a manual search.

Twelve papers were included in the review. Overall success rates were 98%, 93.5%, 93.6% for direct pulp cap (DPC), indirect pulp cap (IPC) and pulpotomy (PP) respectively. Regardless of the VPT technique, there were no significant differences between clinical and radiographic success rates. Completion of root development was achieved in more than 83% of the cases in all VPT techniques.

Thus, all treatment modalities for pulpotomy were equally efficient with high overall success rates. Biodentine showed high success rates regardless of technique. No significant differences were found in the clinical and radiographic success rates between various follow-up intervals. There are no clear conclusions regarding the superiority of either VPT technique on apical closure.

Reference:

Huei Jinn Tong, Kyriaki Seremidi, Eirini Stratigaki, Dimitrios Kloukos, Monty Duggal, Sotiria Gizani, Deep dentine caries management of immature permanent posterior teeth with vital pulp: A systematic review and meta-analysis, Journal of Dentistry, Volume 124,2022, 104214, ISSN 0300-5712, https://doi.org/10.1016/j.jdent.2022.104214.

Keywords:

Huei Jinn Tong, Kyriaki Seremidi, Eirini Stratigaki, Dimitrios Kloukos, Monty Duggal, Sotiria Gizani, Deep, dentine, caries, management, immature, permanent, posterior, teeth, vital, pulp, systematic review, meta-analysis, Journal of Dentistry