Elsevier

Journal of Dentistry

Volume 44, January 2016, Pages 1-7
Journal of Dentistry

Review article
Coronal pulpotomy for cariously exposed permanent posterior teeth with closed apices: A systematic review and meta-analysis

https://doi.org/10.1016/j.jdent.2015.12.005Get rights and content

Abstract

Objectives

This systematic review was performed to evaluate the clinical outcome of coronal pulpotomy treatment to manage carious vital pulp exposure in permanent posterior teeth with closed root apices.

Data/Sources

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used. A search of articles published between 1960 January and 2015 July was conducted in PubMed, EMBASE, and CENTRAL databases.

Study selection

Only studies that performed full coronal pulpotomy for carious vital pulp exposure of permanent posterior teeth and had clinical and radiographic assessments during at least one-year follow-up were qualified for data analyses. The weighted mean success rate (WSR) was the primary outcome and estimated using DerSimonian-Laird random effects model. Out of 299 articles, six studies were included for the analysis of one-year WSR, and five studies were included in the analysis of two-year WSR. The one-year and two-year WSR were 94% (95% confidence interval (CI): [90,99]) and 92% (CI: [84,100]) respectively. Differences in pulp capping and restoration materials did not significantly affect success rates (Two-year WSR in the MTA and MTA-like products group vs. the calcium hydroxide group: 92% (CI: [85,99]) vs. 88% (CI: [76,100]); the amalgam group vs. the composite group: 92% (CI: [81,100]) vs. 93% (CI: [81,100])).

Conclusions

Generally, full coronal pulpotomy had a favorable success rate in treating carious vital pulp exposure of permanent mature teeth with closed root apices. More studies with control group of root canal treated teeth and longer follow-up periods are needed.

Clinical significance

Coronal pulpotomy treatment can be considered as an intermediate treatment option in managing carious vital pulp exposures of permanent teeth with closed root apices. This option may also serve as a substitute to extraction when root canal treatment cannot be performed for low income and uninsured patients or in underserved areas.

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.

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