Review articleCoronal pulpotomy for cariously exposed permanent posterior teeth with closed apices: A systematic review and meta-analysis
Introduction
In the dental practice, when an adult patient is diagnosed with symptomatic or asymptomatic irreversible pulpitis secondary to deep carious pulp involvement, the routine treatment of choice is root canal treatment (RCT), which consists of pulpectomy, followed by root canal therapy and placement of a permanent restoration. If affordable, RCT is the preferred treatment option because of its superior success rate to other treatments [1], [2]. If the patient cannot afford RCT, tooth extraction is the only alternative option to resolve the symptoms [2], [3]. However, there is another potential option that can be used to treat carious exposure of teeth with vital pulps, which is coronal pulpotomy treatment (CPT). This treatment option involves removing the entire coronal pulp tissue and keeping the remaining pulp vital in the canals.
With the current improved understanding of pulp tissue regeneration and the advancement of new materials and technical use, attention was given to study partial pulp tissue regeneration to maintain pulp vitality using minimal invasive endodontic therapies [2]. CPT has been considered as a definitive treatment to manage carious pulp exposure for primary teeth, young immature permanent teeth [4], [5], [6] as well as in treating traumatic pulp exposure in mature teeth [7]. It has been shown that the cariously exposed vital pulp has the ability to repair and heal and remain vital after removing the inflamed pulp tissue [8], [9], [10]. Histological and clinical studies also have shown that CPT can be used successfully to treat carious vital pulp exposure in mature teeth with closed root apices [2], [10], [11]. Compared to RCT, CPT is a less technique sensitive that can be performed by general dental practitioners, particularly for treating posterior permanent teeth. Hence, CPT may increase patients' access to dental care and more clinicians would be able to provide this affordable procedure when the patient's finances prohibit RCT, leaving only extraction as a treatment option.
In recent years, there have been a growing number of studies assessing clinical outcomes of CPT [4], [6], [12], [13], [14]. These studies have generally demonstrated promising clinical results of treating permanent teeth and the results are similar to these of pulpotomy treatments for primary teeth and young permanent teeth [5], [15]. However, there is lack of reviews that systematically demonstrate the clinical outcomes of coronal pulpotomy in treating carious pulp exposure of mature permanent teeth. A recent systematic review has assessed several different methods of vital pulp therapies for mature and immature teeth such as direct pulp capping, partial pulpotomy, and coronal pulpotomy [5]. However, in that review [5], the included studies had different treatment therapies, inconsistent definition of success rate, the follow-up periods were pooled, as well as several duplicate articles were included in the review. The objective of the present systematic review is to specifically assess the success rate of coronal pulpotomy in treating carious vital pulp exposure in permanent posterior teeth with closed root apices in order to evaluate a potential alternative when RCT cannot be performed.
Section snippets
Methods
This systematic review was conducted by following PRISMA guideline principles [15].
Selected studies
Two hundred and ninety-nine articles were found during the search process (Fig. 1). After the preliminary screening of the titles and abstracts to exclude irrelevant articles, an in-depth full-text assessment of the 32 articles was done by the three investigators (C.L, H.A, S.B). Six articles were finally selected [4], [12], [13], [14], [21], [22]; reasons for excluding the articles are summarized in Table 1, and the characteristics of each included article are summarized in Table 2.
Quality assessment of selected studies
The only
Discussion
The results of the present review indicated favorable success rates of coronal pulpotomy in treating permanent posterior teeth with carious vital pulp exposure and closed root apices within two-year follow-up. The results were similar to the success rates of pulpotomy treatment for primary teeth [23], permanent teeth with open root apices and [26], root canal treatment over two years [5], [24]. It has been suggested that a two-year follow-up without radiographic findings and free of patient
Conclusion
Coronal pulpotomy treatment could increase tooth retention by providing a potential option particularly for low-income patients or in under served areas worldwide. However, more studies having longer follow-up, larger sample size and including a control group are needed to validate the possibility of performing CPT as an alternative to RCT.
Acknowledgements
The authors of this review received no financial support and declare no potential conflicts of interest with respect to the authorship and/or publication of this article.
References (39)
- et al.
Three-year outcomes of root canal treatment: mining an insurance database
J. Dentist.
(2015) - et al.
Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review
J. Endododontics
(2011) - et al.
Permanent teeth pulpotomy survival analysis: retrospective follow-up
J. Dentist.
(2015) A paradigm shift in endodontic management of immature teeth: conservation of stem cells for regeneration
J. Dentist.
(2008)- et al.
MTA pulpotomy as an alternative to root canal treatment in children’s permanent teeth in a dental public health setting
J. Dentist.
(2014) - et al.
Primary molar pulpotomy: a systematic review and network meta-analysis
J. Dent.
(2014) Preventive endodontics: vital pulp therapy
Dent. Clin. North Am.
(1967)- et al.
Mineral trioxide aggregate: a comprehensive literature review—part II: leakage and biocompatibility investigations
J. Endodontics
(2010) - et al.
Dissolution of bio-active dentine matrix components by mineral trioxide aggregate
J. Dent.
(2007) - et al.
Changes in the homeostatic mechanism of dental pulp with age: expression of the core-binding factor alpha-1, dentin sialoprotein, vascular endothelial growth factor, and heat shock protein 27 messenger RNAs
J. Endodontics
(2008)
Evaluation of the delivery of endodontic services to the public
J. Endodontics
Coronal pulpotomy technique analysis as an alternative to pulpectomy for preserving the tooth vitality, in the context of tissue egeneration: a correlated clinical study across 4 adult permanent molars
Case Rep. Dentist.
Barriers to improving endodontic care: the views of NHS practitioners
Br. Dent. J.
Should pulp chamber pulpotomy be seen as a permanent treatment? Some preliminary thoughts
Int. Endodontic J.
Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth
Dental Traumatol.
The future role of a molecular approach to pulp-dentinal regeneration
Caries Res.
Histology of irreversible pulpitis premolars treated with mineral trioxide aggregate pulpotomy
Operative Dentist.
MTA pulpotomy of human permanent molars with irreversible pulpitis
Aust. Endododontic J.
Two-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter randomized clinical trial
Clin. Oral Investig.
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