Factors that influence the outcome of pulpotomy in permanent teeth

Abstract

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

Success rate of permanent teeth pulpotomy using bioactive materials: A systematic review and meta‐analysis of randomized clinical trials

“…Conversely, Özgür et al (2017) found that the use of saline solution as irrigant for haemorrhage control was associated with a higher success rate in pulpotomies compared to sodium hypochlorite, although no statistical significance was detected. According to a recent review published by Duncan et al (2022), a variety of factors influence the outcome of pulpotomy in permanent teeth, including the type of capping material used, caries depth, pulp status, level of pulpal biomarkers and final restoration integrity. Other possible influencing factors include exposure type, periodontal condition, pulpal irrigation, magnification, operator experience, operating field isolation and type of pulpotomy, which require further investigation.…”

Treatment outcome of partial pulpotomy using two different calcium silicate materials in mature permanent teeth with symptoms of irreversible pulpitis: A randomized clinical trial

“…Dentinal bridge formation after the pulpotomy procedure is considered to be a significant indicator of a favourable outcome of partial pulpotomy (Duncan et al, 2022; Leye Benoist et al, 2012; Nosrat & Nosrat, 1998). This is because it demonstrates that the pulp remains vital underneath the capping material.…”

“…Βy performing VPT in vital mature teeth, a great number of root canal therapies may be prevented, thus preserving pulp vitality and consequently the health of the tissue. Preservation of pulp vitality is of great importance, due to the maintenance of the defensive mechanism of the pulp tissue and the structural integrity of the tooth (Duncan et al, 2022).…”

Wnt3a‐Loaded Hydroxyapatite Nanowire@Mesoporous Silica Core−Shell Nanocomposite Promotes the Regeneration of Dentin−Pulp Complex via Angiogenesis, Oxidative Stress Resistance, and Odontogenic Induction of Stem Cells

“…Such treatments hold various clinical and biological benefits, such as avoiding tooth loss, restoring tooth functions, and reversing/resisting the progress of diseased tooth condition, [ 3 ] but still result in a high percentage of failure in clinical practice. [ 4–6 ]…”

“…Such treatments hold various clinical and biological benefits, such as avoiding tooth loss, restoring tooth functions, and reversing/resisting the progress of diseased tooth condition, [3] but still result in a high percentage of failure in clinical practice. [4][5][6] The regeneration of the dentin-pulp complex is mainly based on a new population of odontoblast-like cells derived from pulp stem cells in the healthy portion of the pulp, [7] making it essential to protect these progenitor cells and induce their activity. However, pulp exposure is usually accompanied by local accumulation of inflammation mediators, such as cytokines, chemokines, and oxidative stress markers (e.g., reactive oxygen intermediates), [8,9] which, at high concentrations, can cause oxidative damage to the cells.…”