It has been recommended that when treating deep carious lesions, the maintenance of pulpal health should be a primary goal. While this may be achieved by using incomplete or selective caries removal pulp exposure is sometimes inevitable. While root canal treatment has a high success rate improvements in understanding of pulp biology and biomaterials has improved the success of pulpotomy in permanent teeth.
The main aim of the review was to evaluate the success rate of partial pulpotomy in treating permanent posterior teeth with carious vital pulp exposure.
Methods
Searches were conducted in the Medline, Science Direct Cochrane and OpenGrey databases. This was supplemented by hand searches of the journals; Journal of Dentistry; Journal of Endodontics; International Endodontic Journal; Australian Endodontic Journal; and Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. Randomised controlled trials (RCTs) and prospective clinical studies evaluating the success rate of cariously exposed vital human permanent posterior teeth treated with a partial pulpotomy having a minimum 6 months follow-up were considered. Two reviewers selected studies, extracted data and assessed study quality. RCTs were assessed with the Cochrane tool and prospective cohort studies with the Newcastle -Ottawa Scale. Success rates at 1, 12 and 24 months were calculated, and meta-analyses conducted using a random-effects model.
Results
- 11 studies (5 RCTs, 6 cohorts) were included.
- All 5 RCTS were considered to be at unclear risk.
- 5 Cohort studies were considered to be of good quality
Meta-analysis of RCTs
| No. of studies | Success rate (95%CI) | |
| 6 months | 5 | 0.96 (0.87–1.00) |
| 12 months | 4 | 0.94 (0.81–1.00) |
| 24 months | 4 | 0.91 (0.76–1.00) |
Meta-analysis of prospective cohort studies
| No. of studies | Success rate
(95%CI) |
|
| 6 months | 6 | 0.99 (0.97–1.00) |
| 12 months | 6 | 0.98 (0.94–1.00) |
| 24 months | 3 | 0.92 (0.85–0.97) |
Meta-analysis of RCTs and cohort studies
| No. of studies | Success rate
(95%CI) |
|
| 6 months | 11 | 0.98 (0.94–1.00) |
| 12 months | 10 | 0.96 (0.91–0.99) |
| 24 months | 7 | 0.92 (0.83–0.97) |
- The only variable associated with success rate at 12 months follow up was pulp status with the success rate for teeth diagnosed with irreversible pulpitis at the 12-month follow-up = 0.75 (95%CI; 0.62–0.86) compared with 0.98 (95%CI; 0.96–1) for teeth diagnosed with reversible pulpitis.
Conclusions
The authors concluded: –
a partial pulpotomy is considered a reliable treatment option for the treatment of cariously exposed permanent posterior teeth. It presents a high success rate of 92% after 2 years. The preoperative pulp diagnosis results in a significant prognostic factor, and cases diagnosed as irreversible pulpitis result in a lower success rate. There is no significant difference between MTA-like materials and CH as a pulp capping agent nor the other variables evaluated.
Comments
Earlier this week we looked at a review of pulpotomy in immature primary teeth (Dental Elf – 28th Oct 2019). This review looks at partial pulpotomy in cariously exposed posterior permanent teeth. The reviewers have search three major databases and included both RCTS and prospective cohort studies. Interestingly they have chosen to exclude studies with a minimum 80% follow up rate, although one study with 26% drop out was included. This review included studies that treated teeth with open and closed apices with sample sizes that ranged from 10 to 84 although it is not clear whether this represents patients or teeth. The age of the patients ranged from 6-52 years. Final restorations were placed on the same day in 9 out of the 11 studies.
Earlier this year we looked at another review of pulpotomy in permanent teeth (Dental Elf – 22nd July 2019). That review included 17 studies and also suggested that pulpotomy is a potential treatment option for of cariously exposed permanent teeth. So while these reviews suggest a role for pulpotomy additional, larger high quality well-reported studies are needed to clarify effectiveness.
Links
Primary Paper
Elmsmari F, Ruiz XF, Miró Q, Feijoo-Pato N, Durán-Sindreu F, Olivieri JG. Outcome of Partial Pulpotomy in Cariously Exposed Posterior Permanent Teeth: A Systematic Review and Meta-analysis. J Endod. 2019 Sep 9. pii:S0099-2399(19)30512-6. doi: 10.1016/j.joen.2019.07.005. [Epub ahead of print] Review. PubMed PMID: 31515048.
Other references
Dental Elf – 28th Oct 2019
Dental Elf – 22nd July 2019
Dental Elf – Pulpotomy blogs
