Factors Related to Pulp Survival After Complicated Crown Fracture Following Vital Pulp Therapy: A Systematic Review and Meta-analysis

Tzanetakis, Giorgos N.; Tsiouma, Ourania; Mougiou, Eleni; Koletsi, Despina

doi:10.1016/j.joen.2022.01.013

Cited by 6 publications

(12 citation statements)

References 51 publications

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“…Longer‐term follow‐up greater than 3 years highlighted that the success of the pulpotomy procedure did not reduce with time (Donnelly et al, 2022), a feature evident after carious exposure (Cushley et al, 2019). This finding was reported in other systematic reviews on the subject, which highlighted a highly successful procedure based on low‐quality evidence (Matoug‐Elwerfelli et al, 2022; Tzanetakis et al, 2022, Table 3). Other systematic reviews analysing carious exposure and full pulpotomy in teeth with symptoms indicative of irreversible pulpitis revealed pooled success rates of 94% clinical and 88% radiographic at 3 years, albeit from studies with a high level of bias (Cushley et al, 2019).…”

Section: Reviewsupporting

confidence: 73%

“…In a similar manner to pulp status, the type of exposure highlights the likely presence or absence of bacteria and inflammation in the pulp. Even with a lack of direct comparison, inference can however be drawn from studies and systematic reviews that analyse pulpotomy as a treatment for carious exposure (Alqaderi et al, 2016; Cushley et al, 2019; Li et al, 2019, Table 2) and traumatic exposure (Donnelly et al, 2022; Matoug‐Elwerfelli et al, 2022; Tzanetakis et al, 2022, Table 3). A recent systemic review focussing on complicated crown fracture included seven retrospective clinical studies and presented overall success rates ranging from 75% to 96% after at least 1‐year follow‐up; however, it was noted that none of the included studies were of high quality (Donnelly et al, 2022).…”

Section: Reviewmentioning

confidence: 99%

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Factors that influence the outcome of pulpotomy in permanent teeth

et al. 2022

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The promotion of minimally invasive treatments focussed on the maintenance of pulp vitality has become a priority area in Endodontics. These vital pulp treatments (VPT) include partial and full pulpotomy, during which diseased coronal pulp tissue is removed prior to placement of a capping biomaterial and restoration. Traditionally, pulpotomies were confined to the treatment of carious primary and traumatized permanent teeth. However, these treatments have now been proposed as definitive solutions for cariously exposed permanent teeth with mild symptoms or even symptoms indicative of irreversible disease. Until recently, it was recommended that carious exposure of mature permanent teeth be managed by root canal treatment. The promotion of pulpotomy as an alternative treatment has opened up a wave of laboratory and clinical research aimed at improving therapies or evaluating clinical outcomes.In modern evidence-based endodontics, it is imperative that the outcomes of both partial and full pulpotomy are considered and important prognostic factors identified, so that improvements can be made to aid clinical decision-making and to direct new research. In this narrative review, the outcomes of partial and full pulpotomy are discussed, before analysis of patient, intraoperative and postoperative factors that influence the outcome of the pulpotomy procedure. The review highlights that although partial and full pulpotomy for the treatment of even pulpal disease are highly successful procedures, this is based on low-quality evidence with a lack of prospective, comparative trials investigating potential prognostic factors. Based on current evidence, it appears that age, gender, tooth type, root development and intraoperative pulpal haemorrhage do not impact significantly on pulpotomy outcome, whilst others such as caries depth, inflammatory status of the pulp, capping material, level of inflammatory pulpal-biomarkers and the final restoration integrity do. Other factors, including the influence of exposure type, periodontal condition, pulpal lavage, magnification, operator experience, isolation of the operating field and type of pulpotomy, require further experimental investigation before definitive conclusions can be made relating to the success of the pulpotomy procedure. Finally, there is not only a need for future well-designed prospective research addressing these issues but also

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Section: Reviewsupporting

confidence: 73%

Section: Reviewmentioning

confidence: 99%

Factors that influence the outcome of pulpotomy in permanent teeth

et al. 2022

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“…The primary goal in the treatment of permanent teeth with open apex is to preserve the life of the pulp through vital pulp therapy (VPT) for the occurrence of apicogenesis. Direct pulp capping and pulpotomy represent the VPT techniques used on open apex teeth for the natural development of tooth roots [ 20 ]. In recent years, the use of stem cells represented a new and possible technique for apexification and regenerative endodontics [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Using Odontoblasts Derived from Dog Endometrial Stem Cells Encapsulated in Fibrin Gel Associated with BMP-2 in a Rat Pulp-Capping Model

Hoveizi

Naddaf

Ahmadianfar

et al. 2023

CIMB

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This study aimed to treat dental injuries by utilizing one of the most advanced tissue engineering techniques. In this study, an in vitro model was employed to investigate the proliferation and odontogenic differentiation of canine endometrial stem cells (C-EnSCs). Furthermore, the dentin regeneration potential of odontoblast like-cells (OD) derived from C-EnSCs was assessed in rats. The C-EnSCs were isolated by the enzymatic method and identified by flow cytometry. The C-EnSCs were encapsulated in fibrin gel associated with signaling factors to create the proper conditions for cell growth and differentiation. Then, the OD cells were associated with bone morphologic protein-2 (BMP-2) to promote dentin formation in vivo. The animal model used to evaluate the regenerative effect of cells and biomaterials included the preparation of the left maxillary first molar of rats for direct pulp capping operation. Animals were divided into four groups: group 1, a control group without any treatment, group 2, which received fibrin, group 3, which received fibrin with ODs (fibrin/ODs), and group 4, which received fibrin with ODs and BMP-2 (fibrin/ODs/BMP-2). The morphological observations showed the differentiation of C-EnSCs into adipose, bone, neural cells, and ODs. Furthermore, the histomorphometric data of the treated teeth showed how fibrin gel and BMP2 at a concentration of 100 ng/mL provided an optimal microenvironment for regenerating dentin tissue in rats, which was increased significantly with the presence of OD cells within eight weeks. Our study showed that using OD cells derived from C-EnSCs encapsulated in fibrin gel associated with BMP2 can potentially be an appropriate candidate for direct pulp-capping and dentin regeneration.

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“…Furthermore, we must recognize that the healing scenario is complex and multifactorial related to patient (e.g., age and gender), trauma (e.g., diagnoses, stage of root development, time interval), or treatment factors. 9 Data from a prevalence study showed that only 20% of children sought treatment promptly after TDIs, and treatment delays were common. 15 In the current study, four times as many cases with uncomplicated crown fractures (14.1%) were referred for 1 week as those with complicated crown fractures (3.7%).…”

Section: Discussionmentioning

confidence: 99%

“…8 Numerous studies reported that concurrent periodontal injury was detected as a reliable indicator of pulp tissue longevity. 5,9,10 However, few studies further subdivide luxation according to the severity of injuries to the periodontal tissues. Currently, subjects in many studies included fracture concomitant with intrusion and extrusion luxation, which may have overwhelmingly negative effects on prognosis.…”

Section: Introductionmentioning

confidence: 99%

Treatment outcomes of permanent teeth with uncomplicated and complicated crown fractures and factors associated with pulp survival: A retrospective study

Cheng,

Li,

et al. 2023

Dental Traumatology

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BackgroundCrown fracture is the most common injury in permanent teeth. This study aimed to evaluate the treatment outcomes of permanent teeth with uncomplicated and complicated crown fractures and to investigate potential factors.Materials and MethodsThis retrospective study included patients who experienced crown fractures in permanent teeth from 2018 to 2021 with at least 12 months of follow‐up. All complicated crown fractured teeth were treated with pulpotomy, while for teeth with uncomplicated crown fractures, three treatments (restoration, indirect pulp capping, or pulpotomy) were employed. The chi‐square test was used to compare the prognosis of teeth with uncomplicated and complicated crown fractures. Potential factors associated with pulp survival including gender, interval, root development, enamel infraction, mobility, concomitant luxation injury, treatment, and coronal restoration were identified via Cox regression analysis.ResultsA total of 307 teeth from 220 children (average age = 9.3 ± 1.4 years; age range, 6–14 years) with a median follow‐up of 23 months were included, and 82.1% of all teeth had immature roots. Complicated crown fractured teeth (93.6%, 102/109) had a significantly higher success rate compared with uncomplicated crown fractured teeth (85.4%, 169/198) (p < .05). Pulpotomy (96.9%) had the highest success rate of all treatments for uncomplicated crown fractures, followed by only restoration (85.0%) and indirect pulp capping (76.9%). The success rate of teeth that received pulpotomy was significantly higher than those treated by indirect pulp capping (p < .05). In uncomplicated crown fractures, teeth with Class II mobility were more vulnerable to failure than teeth without abnormal mobility (HR = 34.83; 95% CI, 9.59–126.56; p < .05); teeth that received pulpotomy were less prone to failure than teeth that received indirect pulp capping (HR = 13.53; 95% CI, 1.58–115.72; p < .05).ConclusionCrown fractures treated with conservative pulp treatments had a relatively highly favorable prognosis. The prognosis of uncomplicated crown fractured teeth was impacted by the severity of periodontal injury and treatment strategies. Accurate diagnosis and identification of micro‐exposures are important. Dentists should take multiple risk factors into account and select optimal treatment strategies.

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Factors Related to Pulp Survival After Complicated Crown Fracture Following Vital Pulp Therapy: A Systematic Review and Meta-analysis

Cited by 6 publications

References 51 publications

Factors that influence the outcome of pulpotomy in permanent teeth

Factors that influence the outcome of pulpotomy in permanent teeth

Using Odontoblasts Derived from Dog Endometrial Stem Cells Encapsulated in Fibrin Gel Associated with BMP-2 in a Rat Pulp-Capping Model

Treatment outcomes of permanent teeth with uncomplicated and complicated crown fractures and factors associated with pulp survival: A retrospective study

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