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

Abstract

BackgroundThe results of vital pulp treatments in permanent teeth have been encouraging. Currently, pulpotomy treatment for permanent teeth primarily utilizes mineral trioxide aggregate (MTA) as the dressing material, followed by calcium hydroxide. While other calcium‐silicate‐based cements have been suggested for pulpotomy, there is a limited number of studies evaluating their long‐term effectiveness.ObjectivesThe objective of this systematic review and meta‐analysis was to evaluate the success rate of pulpotomies performed on permanent teeth, comparing the use of ProRoot MTA with that of calcium hydroxide and other bioceramic materials.MethodsA comprehensive search was conducted in several electronic databases, including PubMed, Cochrane Library, Scopus, Web of Science, Embase and Science Direct until December 2022. The search was guided by PICOS criteria, including only randomized clinical trials (RCTs) that evaluated the success rate of pulpotomy treatments in permanent teeth using ProRoot MTA in comparison to calcium hydroxide and other bioceramic materials. The quality of the included studies was assessed using the RoB‐2 tool to evaluate the risk of bias, and relevant data were extracted and analysed in RevMan software 5.3 using fixed‐effect models. The GRADE tool was used to determine the overall quality of evidence.ResultsThe initial search retrieved 1072 studies and, after eliminating duplicates, 677 studies were screened and 28 studies were considered for eligibility. In the final selection process, 16 studies were included in the systematic review, with 10 being determined as having a high risk of bias. Pulpotomy showed an overall mean success rate of 92% after 1 year. The meta‐analysis indicated a significantly higher success rate for pulpotomies utilizing MTA in comparison with calcium hydroxide, while no significant difference was seen between MTA and calcium‐enriched mixture (CEM) or Biodentine. The GRADE assessment revealed an overall low level of evidence for the included studies.DiscussionMost randomized controlled trials exhibited a significant absence of control over confounding factors.ConclusionsThis systematic review and meta‐analysis demonstrate that pulpotomy is a highly effective treatment for managing permanent teeth. The results indicate that the success rate of pulpotomy using ProRoot MTA is significantly higher than when using calcium hydroxide. However, the certainty of evidence supporting these findings is low, and there is a need for well‐designed RCTs to assess the long‐term outcomes of pulpotomy using newer bioceramic materials.RegistrationThis systematic review was registered in the PROSPERO database (registration number CRD42023393970).

Resolvin D2-induced reparative dentin and pulp stem cells after pulpotomy in a rat model

“…RvD2 is metabolized in vivo within a few days [ 43 ]; therefore, a slow-release delivery system may be more efficacious. In addition, the recent standard for preserving dental pulp has become to use MTA [ 6 , 7 ], however, our purpose is to investigate the effects of RvD2 on the pulpal tissue after pulpotomy. Either MTA or calcium hydroxide paste may serve as the positive control for the calcification of pulpal tissue.…”

“…Calcium hydroxide has long been used as the gold standard [ 4 , 5 ]. Currently, mineral trioxide aggregate (MTA) is replacing calcium hydroxide preparations as the optimal material based on clinical findings [ 6 , 7 ].…”

Exploring vital pulp Therapies: A bibliometric analysis of the most cited articles

“…Although no capping material presents all of the qualities mentioned, as the repair process of the dentine-pulp complex becomes better understood, new materials emerge aiming at a more beneficial tissue response ( Giraud et al, 2019 , Tzanetakis et al, 2023 ). Currently, there are several techniques or agents that are supposed to maintain the vitality of the coronary or radicular pulp, including: calcium hydroxide, mineral trioxide aggregate (MTA) and repair bioceramics ( Cushley et al, 2022 , Silva et al, 2023 ).…”

Vital Pulp Therapy in Permanent Teeth Diagnosed with Symptomatic Irreversible Pulpitis: Reports with Long-Term Controls

“…However, there is a lack of long-term follow-up studies that could further support the existing research. Two published studies, a systematic review and a meta-analysis of randomized clinical trials, suggest the need for studies with extended follow-up periods [ 17 , 18 ]. Therefore, the objective of this paper is to present a case series comprising 8 clinical cases of permanent teeth diagnosed with irreversible pulpitis and managed with partial pulpotomy and total pulpotomy, with follow-up assessments conducted for a minimum of 2 years.…”